Provider Demographics
NPI:1609448166
Name:CLEMMONS, MELISSA T (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:T
Last Name:CLEMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 ROCKY TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1469
Mailing Address - Country:US
Mailing Address - Phone:407-451-7304
Mailing Address - Fax:407-451-7304
Practice Address - Street 1:6217 ROCKY TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1469
Practice Address - Country:US
Practice Address - Phone:407-451-7304
Practice Address - Fax:407-296-8813
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW184661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical