Provider Demographics
NPI:1811293079
Name:RYCHOK, MELANIE (MSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:RYCHOK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 HAMILTON ST
Mailing Address - Street 2:UNIT 204
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3635
Mailing Address - Country:US
Mailing Address - Phone:862-223-9723
Mailing Address - Fax:
Practice Address - Street 1:1315 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5601
Practice Address - Country:US
Practice Address - Phone:267-603-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0167711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical