Provider Demographics
NPI:1568794865
Name:RUSAK, MELISSA (MSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RUSAK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:PENMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:5550 HAMSTEAD XING
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7014
Mailing Address - Country:US
Mailing Address - Phone:724-980-8633
Mailing Address - Fax:
Practice Address - Street 1:5550 HAMSTEAD XING
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7014
Practice Address - Country:US
Practice Address - Phone:724-980-8633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst