Healthcare Provider Details

I. General information

NPI: 1174113450
Provider Name (Legal Business Name): MELISSA KUT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E MARKET ST
YORK PA
17402-2841
US

IV. Provider business mailing address

4415 BEAUMONT RD
DOVER PA
17315-3468
US

V. Phone/Fax

Practice location:
  • Phone: 717-774-1000
  • Fax: 717-668-8353
Mailing address:
  • Phone: 717-817-0121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW137540
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: