Healthcare Provider Details

I. General information

NPI: 1780277665
Provider Name (Legal Business Name): MELINDA AMY HUTTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W. BARBARA PL.
ORACLE AZ
85623
US

IV. Provider business mailing address

PO BOX 1327
ORACLE AZ
85623-1327
US

V. Phone/Fax

Practice location:
  • Phone: 631-484-2763
  • Fax:
Mailing address:
  • Phone: 631-484-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR44423-01
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: