Provider Demographics
NPI:1578883112
Name:LUMPKIN, MELVIN L (MSW)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:L
Last Name:LUMPKIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10640 GRIFFIN RD
Mailing Address - Street 2:SUITE C-105
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3214
Mailing Address - Country:US
Mailing Address - Phone:786-262-2843
Mailing Address - Fax:954-434-5545
Practice Address - Street 1:10640 GRIFFIN RD
Practice Address - Street 2:SUITE C-105
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3214
Practice Address - Country:US
Practice Address - Phone:786-262-2843
Practice Address - Fax:954-434-5545
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-06
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid