Healthcare Provider Details

I. General information

NPI: 1295247732
Provider Name (Legal Business Name): MELISSA DUTCHER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 N SEKOL AVE
SCRANTON PA
18504-1038
US

IV. Provider business mailing address

228 S MAIN AVE
SCRANTON PA
18504-2545
US

V. Phone/Fax

Practice location:
  • Phone: 570-241-8679
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW132003
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: