Provider Demographics
NPI:1952428633
Name:HERRERA, MELANIE JEANEAN (LSWA)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:JEANEAN
Last Name:HERRERA
Suffix:
Gender:F
Credentials:LSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6503 WINDSOR MILL RD
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5380
Mailing Address - Country:US
Mailing Address - Phone:443-429-4510
Mailing Address - Fax:
Practice Address - Street 1:6401 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2152
Practice Address - Country:US
Practice Address - Phone:443-429-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA05098104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker