Healthcare Provider Details

I. General information

NPI: 1497686471
Provider Name (Legal Business Name): MELISSA RUDACILLE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 VALE RD
BEL AIR MD
21014-2301
US

IV. Provider business mailing address

12773 GLESSICK SCHOOL RD
FELTON PA
17322-8273
US

V. Phone/Fax

Practice location:
  • Phone: 443-652-1985
  • Fax:
Mailing address:
  • Phone: 717-825-0679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34767
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: