Healthcare Provider Details

I. General information

NPI: 1447728126
Provider Name (Legal Business Name): MELISSA KATHRYN BROWN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2018
Last Update Date: 11/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 W 25TH ST
CLEVELAND OH
44113-3170
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-363-2122
  • Fax:
Mailing address:
  • Phone: 216-363-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1302027
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: