Provider Demographics
NPI:1396350310
Name:RICHARDSON, MELANIA JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:MELANIA
Middle Name:JEAN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELANIA
Other - Middle Name:JEAN
Other - Last Name:MACIP-BILLBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10528 PARKERS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-5804
Mailing Address - Country:US
Mailing Address - Phone:813-368-0198
Mailing Address - Fax:
Practice Address - Street 1:4700 N HABANA AVE STE 703
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7122
Practice Address - Country:US
Practice Address - Phone:813-678-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW158151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical