Healthcare Provider Details

I. General information

NPI: 1932975430
Provider Name (Legal Business Name): MELODY FAYE CUEVAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELODY FAYE WEISBAUM LMSW

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CLEARWATER DR
MONROE GA
30655-7320
US

IV. Provider business mailing address

240 MITCHELL BRIDGE RD
ATHENS GA
30606-2043
US

V. Phone/Fax

Practice location:
  • Phone: 210-724-0119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW010899
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: