Healthcare Provider Details

I. General information

NPI: 1073255311
Provider Name (Legal Business Name): MELANATED HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BROOKLINE BLVD OFC 2
HAVERTOWN PA
19083-3802
US

IV. Provider business mailing address

2 BROOKLINE BLVD OFC 2
HAVERTOWN PA
19083-3802
US

V. Phone/Fax

Practice location:
  • Phone: 267-995-4065
  • Fax:
Mailing address:
  • Phone: 267-800-5420
  • Fax: 267-800-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMBER SMITH
Title or Position: OWNER
Credential: LCSW
Phone: 267-800-5420