Provider Demographics
NPI:1508174087
Name:WHITE, MELISSA J (MSSA, LISW-S)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSSA, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 N KERRWOOD DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-5207
Mailing Address - Country:US
Mailing Address - Phone:724-346-1569
Mailing Address - Fax:
Practice Address - Street 1:295 N KERRWOOD DR
Practice Address - Street 2:SUITE 110
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5207
Practice Address - Country:US
Practice Address - Phone:724-346-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-19
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 0028289-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical