Provider Demographics
NPI:1659618841
Name:NEWPORT, MELISSA N (LSW)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:N
Last Name:NEWPORT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11730 KILE RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9591
Mailing Address - Country:US
Mailing Address - Phone:440-537-4221
Mailing Address - Fax:
Practice Address - Street 1:11730 KILE RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9591
Practice Address - Country:US
Practice Address - Phone:440-537-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1201583104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker