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General NPI Number Information
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NPI Number | 1457714404
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Entity Type | Individual
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Provider Name | MELISSA J LANDRAM LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 01/26/2019
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Provider Practice Location Address
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Address Line | 10300 BROOKRIDGE VILLAGE BLVD STE 202
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City | LOUISVILLE
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State | KY
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Zip | 40291-4474
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Country | US
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Telephone | 502-314-2237
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Fax | 844-379-5157
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Provider Business Mailing Address
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Address Line | 823 ALLISON AVE
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City | BARDSTOWN
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State | KY
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Zip | 40004-1760
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Country | US
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Telephone | 502-827-4699
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7483
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 253835
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License Number State | KY
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