Provider Demographics
NPI:1720866221
Name:MELVIN, DIANE R (MSSA, LSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:R
Last Name:MELVIN
Suffix:
Gender:F
Credentials:MSSA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5561 RIDGEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-4618
Mailing Address - Country:US
Mailing Address - Phone:440-382-7101
Mailing Address - Fax:
Practice Address - Street 1:5561 RIDGEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-4618
Practice Address - Country:US
Practice Address - Phone:440-382-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.10009781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical