Healthcare Provider Details

I. General information

NPI: 1831410398
Provider Name (Legal Business Name): MELISSA MARIE MARKOWTIZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W LINCOLN HWY SUITE 206 A
EXTON PA
19341-2559
US

IV. Provider business mailing address

504 RAYMOND DR
WEST CHESTER PA
19380-2804
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-2088
  • Fax: 610-363-2080
Mailing address:
  • Phone: 610-842-0828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016571
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: