Provider Demographics
NPI:1205343100
Name:MELCHER, KEVIN JAMES PAUL (MSW, LSW)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JAMES PAUL
Last Name:MELCHER
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 W LYNBROOK RD
Mailing Address - Street 2:
Mailing Address - City:COLLINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1010
Mailing Address - Country:US
Mailing Address - Phone:267-408-3749
Mailing Address - Fax:
Practice Address - Street 1:225 S 69TH ST
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-4212
Practice Address - Country:US
Practice Address - Phone:610-352-8943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134635104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker