=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982537445
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA STAFFORD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2026
-----------------------------------------------------
Last Update Date | 06/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 806 TORREY LN
-----------------------------------------------------
City | BOALSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16827-1553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-561-5633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 806 TORREY LN
-----------------------------------------------------
City | BOALSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16827-1553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SW139615
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------