Provider Demographics
NPI:1851573299
Name:HEPBURN, MELANIE MARIE
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:MARIE
Last Name:HEPBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 SAM SNEAD CIR
Mailing Address - Street 2:
Mailing Address - City:ETTERS
Mailing Address - State:PA
Mailing Address - Zip Code:17319-9746
Mailing Address - Country:US
Mailing Address - Phone:717-932-1607
Mailing Address - Fax:
Practice Address - Street 1:5351 JAYCEE AVE # C
Practice Address - Street 2:SUITE1
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2938
Practice Address - Country:US
Practice Address - Phone:717-657-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000424101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional