MEDICARE: MS. MELISSA DALE DAVOLI L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C003329	NC
2	104100000X	Social Worker	C003329	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053424341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA DALE DAVOLI L.C.S.W.

Provider Business Mailing Address
First Line	:	8508 CLIVEDON DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-3990
Country	:	US
Telephone Number	:	919-389-1878
Fax Number	:	919-861-8893

Provider Business Practice Location Address
First Line	:	146 WIND CHIME CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-6433
Country	:	US
Telephone Number	:	919-389-1878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	08/30/2008

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