MEDICARE: MEREDITH MELVIN-COSGROVE LSW

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	104100000X	Social Worker	SW125475	PA

General Provider Information

NPI Number	:	1669612982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH MELVIN-COSGROVE LSW

Provider Business Mailing Address
First Line	:	597 WYOMING AVE
Second Line	:
City	:	WYOMING
State	:	PA
Zip	:	18644-1806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	341 WYOMING AVE
Second Line	:
City	:	WEST PITTSTON
State	:	PA
Zip	:	18643-2839
Country	:	US
Telephone Number	:	570-342-8434
Fax Number	:

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

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	02/26/2009

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