Provider Demographics
NPI:1639417488
Name:GRADY, MELISSA DELLE (PHD, LICSW)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:DELLE
Last Name:GRADY
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 TOURNAY RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1841
Mailing Address - Country:US
Mailing Address - Phone:202-549-3221
Mailing Address - Fax:
Practice Address - Street 1:5225 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 513
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2014
Practice Address - Country:US
Practice Address - Phone:202-549-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500793661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical