MEDICARE: CARA MELVIN MSW, LISW

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	104100000X	Social Worker	2047-122	WI
2	104100000X	Social Worker	20418	MN

General Provider Information

NPI Number	:	1528810827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARA MELVIN MSW, LISW

Provider Business Mailing Address
First Line	:	811 GLENWOOD AVE STE 210
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-1804
Country	:	US
Telephone Number	:	651-468-4795
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 GLENWOOD AVE STE 210
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-1804
Country	:	US
Telephone Number	:	651-468-4795
Fax Number	:

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

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	04/02/2024

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