Healthcare Provider Details

I. General information

NPI: 1891003588
Provider Name (Legal Business Name): MELANIE J PREPETIT LISW-SUPV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 MENTOR AVE
MENTOR OH
44060-6412
US

IV. Provider business mailing address

11801 BUCKEYE RD
CLEVELAND OH
44120-2620
US

V. Phone/Fax

Practice location:
  • Phone: 440-255-1700
  • Fax:
Mailing address:
  • Phone: 216-831-2255
  • Fax: 216-378-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0010212-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: