Healthcare Provider Details

I. General information

NPI: 1982119301
Provider Name (Legal Business Name): MELISSA A LENTINE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA A O'BRIEN LCSW

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 PORTAGE AVE STE 105
SOUTH BEND IN
46616-1414
US

IV. Provider business mailing address

612 LINDSEY ST
SOUTH BEND IN
46616-1219
US

V. Phone/Fax

Practice location:
  • Phone: 574-300-6977
  • Fax: 574-381-5572
Mailing address:
  • Phone: 574-300-6977
  • Fax: 574-381-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number33007629A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: