Provider Demographics
NPI:1821525353
Name:MARCOTTE, MELODY (MA, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:
Last Name:MARCOTTE
Suffix:
Gender:F
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8695 ARCHER AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1283
Mailing Address - Country:US
Mailing Address - Phone:708-480-2853
Mailing Address - Fax:
Practice Address - Street 1:8695 ARCHER AVE STE 21
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-1283
Practice Address - Country:US
Practice Address - Phone:708-480-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490187821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical