Provider Demographics
NPI:1518179290
Name:MELVIN, KECIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:KECIA
Middle Name:
Last Name:MELVIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-3441
Mailing Address - Country:US
Mailing Address - Phone:973-420-6798
Mailing Address - Fax:
Practice Address - Street 1:570 SOUTH AVE E BLDG A
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3266
Practice Address - Country:US
Practice Address - Phone:973-420-6798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054272001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical