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General NPI Number Information
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NPI Number | 1285356410
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Entity Type | Individual
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Provider Name | MELISSA BAZYDLO LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 120 VALLEY GREEN LN STE 660
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2079
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Country | US
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Telephone | 888-227-3898
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 CONSHOHOCKEN AVE APT 8111
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City | PHILADELPHIA
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State | PA
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Zip | 19131-5459
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Country | US
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Telephone | 734-904-7880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW022707
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License Number State | PA
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