Provider Demographics
NPI:1508242181
Name:MELVIN, MARY PAT (LSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PAT
Last Name:MELVIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N MAIN ST
Mailing Address - Street 2:PO BOX 315
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1836
Mailing Address - Country:US
Mailing Address - Phone:570-654-0788
Mailing Address - Fax:
Practice Address - Street 1:9 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1836
Practice Address - Country:US
Practice Address - Phone:570-654-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW009917L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker