Provider Demographics
NPI:1952752776
Name:MISENCIK, MELISSA (LISW-S)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MISENCIK
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26220 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4016
Mailing Address - Country:US
Mailing Address - Phone:440-434-2733
Mailing Address - Fax:440-848-8666
Practice Address - Street 1:26220 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4016
Practice Address - Country:US
Practice Address - Phone:440-434-2733
Practice Address - Fax:440-848-8666
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0800216-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical