Healthcare Provider Details

I. General information

NPI: 1700338514
Provider Name (Legal Business Name): MELISSA GRAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 SCHOENERSVILLE RD
BETHLEHEM PA
18017-3574
US

IV. Provider business mailing address

5522 TANGLEWOOD LN LN
ALLENTOWN PA
18106-9175
US

V. Phone/Fax

Practice location:
  • Phone: 610-297-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017500
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: