Provider Demographics
NPI:1659990307
Name:MELENDEZ, RADAMES (MHS)
Entity Type:Individual
Prefix:MR
First Name:RADAMES
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4359
Mailing Address - Country:US
Mailing Address - Phone:717-390-9086
Mailing Address - Fax:717-390-9066
Practice Address - Street 1:1148 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4359
Practice Address - Country:US
Practice Address - Phone:717-390-9086
Practice Address - Fax:717-390-9066
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1102899457Medicaid