Provider Demographics
NPI:1740588896
Name:TEFERRA, MELISSA QUINN (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:QUINN
Last Name:TEFERRA
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DEE
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:10524 MELODY MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1317
Mailing Address - Country:US
Mailing Address - Phone:904-654-6678
Mailing Address - Fax:
Practice Address - Street 1:4651 SALISBURY RD STE 400
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6187
Practice Address - Country:US
Practice Address - Phone:904-654-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-13
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW114301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical