Healthcare Provider Details

I. General information

NPI: 1740632173
Provider Name (Legal Business Name): MELANIE LYNN HARRIS THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 YORK RD SUITE 202
BALTIMORE MD
21212-3610
US

IV. Provider business mailing address

6001 WALTHER AVE
BALTIMORE MD
21206-2338
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-1022
  • Fax:
Mailing address:
  • Phone: 443-962-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number21128
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: