Healthcare Provider Details

I. General information

NPI: 1811293079
Provider Name (Legal Business Name): MELANIE RYCHOK MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 SPRUCE ST
PHILADELPHIA PA
19107-5601
US

IV. Provider business mailing address

1234 HAMILTON ST UNIT 204
PHILADELPHIA PA
19123-3635
US

V. Phone/Fax

Practice location:
  • Phone: 267-603-3101
  • Fax:
Mailing address:
  • Phone: 862-223-9723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016771
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: