Healthcare Provider Details

I. General information

NPI: 1407979834
Provider Name (Legal Business Name): MELISSA M HUBER LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA M WUECNHER LCSW-C

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PERRYVILLE DRIVE
PERRY POINT MD
21902
US

IV. Provider business mailing address

601 PERRYVILLE DRIVE
PERRY POINT MD
21902
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax:
Mailing address:
  • Phone: 410-642-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10603
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: