Provider Demographics
NPI:1487018164
Name:CARLISLE, MELISSA (LISW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 HAMPTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313
Mailing Address - Country:US
Mailing Address - Phone:330-819-1284
Mailing Address - Fax:
Practice Address - Street 1:715 HAMPTON RIDGE DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5023
Practice Address - Country:US
Practice Address - Phone:330-819-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 15004021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical