Provider Demographics
NPI:1518634468
Name:DOLETZKY, MELISSA BETH (LLMSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BETH
Last Name:DOLETZKY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9658 FLEMING RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-9541
Mailing Address - Country:US
Mailing Address - Phone:734-904-1680
Mailing Address - Fax:
Practice Address - Street 1:5401 MCAULEY DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1011
Practice Address - Country:US
Practice Address - Phone:734-786-2327
Practice Address - Fax:734-786-4915
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011072621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical