Healthcare Provider Details

I. General information

NPI: 1467128942
Provider Name (Legal Business Name): MELISSA HOUSEMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 UNIVERSITY PKWY STE 304
LAKEWOOD RANCH FL
34240-9048
US

IV. Provider business mailing address

6600 UNIVERSITY PKWY STE 304
LAKEWOOD RANCH FL
34240-9048
US

V. Phone/Fax

Practice location:
  • Phone: 833-769-3524
  • Fax: 786-206-5877
Mailing address:
  • Phone: 833-769-3524
  • Fax: 786-206-5877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22634
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2405903
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number258691
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: