MEDICARE: MELISSA C GEORGE MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1639407455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA C GEORGE MSW

Provider Business Mailing Address
First Line	:	5615 HADFIELD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-4603
Country	:	US
Telephone Number	:	215-200-8584
Fax Number	:	215-727-5642

Provider Business Practice Location Address
First Line	:	5615 HADFIELD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-4603
Country	:	US
Telephone Number	:	215-200-8584
Fax Number	:	215-727-5642

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2009
Last Update Date	:	12/18/2009

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