Provider Demographics
NPI:1023346434
Name:GREM, MELANIE ANNE ELEANOR (LSW)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ANNE ELEANOR
Last Name:GREM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:ANNE
Other - Last Name:SHUMAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:960 CENTURY DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050
Mailing Address - Country:US
Mailing Address - Phone:717-982-2926
Mailing Address - Fax:717-795-0407
Practice Address - Street 1:960 CENTURY DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050
Practice Address - Country:US
Practice Address - Phone:717-795-0330
Practice Address - Fax:717-795-0407
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
PASW127843101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor