Provider Demographics
NPI:1003248501
Name:COUPLAND, MELANIE GONSECKI (LCSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:GONSECKI
Last Name:COUPLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ANN
Other - Last Name:GONSECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1051 CATALPA DR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2303
Mailing Address - Country:US
Mailing Address - Phone:302-562-2107
Mailing Address - Fax:
Practice Address - Street 1:1051 CATALPA DR
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2303
Practice Address - Country:US
Practice Address - Phone:302-562-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0233801041C0700X
104100000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program