MEDICARE: MRS. PENNY COZETTE MELTON LMSW

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	27892	MD
2	104100000X	Social Worker	27892	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27892	OTHER	MD	CIGNA, AETNA

General Provider Information

NPI Number	:	1215649710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PENNY COZETTE MELTON LMSW

Provider Business Mailing Address
First Line	:	2707 KILDAIRE DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21234-7634
Country	:	US
Telephone Number	:	410-624-6395
Fax Number	:

Provider Business Practice Location Address
First Line	:	2707 KILDAIRE DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21234-7634
Country	:	US
Telephone Number	:	410-624-6395
Fax Number	:

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

Provider Enumeration Date	:	12/16/2022
Last Update Date	:	12/16/2022

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Directions to “ MRS. PENNY COZETTE MELTON LMSW” Practice Location

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