Healthcare Provider Details

I. General information

NPI: 1245622505
Provider Name (Legal Business Name): MELISSA A. MIGLIAZZA MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9815 ROOSEVELT BLVD SUITE B
PHILADELPHIA PA
19114-1011
US

IV. Provider business mailing address

1440 RUSSELL RD
PAOLI PA
19301-1236
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6464
  • Fax: 610-981-6078
Mailing address:
  • Phone: 610-644-6464
  • Fax: 610-981-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW131564
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: