MEDICARE: KAREN MELICI MSW, LCSW

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	CW018309	PA
2	1041C0700X	Clinical Social Worker	44SC04607500	NJ

General Provider Information

NPI Number	:	1114084282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN MELICI MSW, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 783311
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-3311
Country	:	US
Telephone Number	:	484-884-4500
Fax Number	:	484-884-0699

Provider Business Practice Location Address
First Line	:	6451 VILLAGE LN
Second Line	:
City	:	MACUNGIE
State	:	PA
Zip	:	18062-8484
Country	:	US
Telephone Number	:	610-967-2772
Fax Number	:	610-967-2559

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

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	12/01/2015

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