MEDICARE: MELINDA AMY HUTTON 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	R44423-01	NY

General Provider Information

NPI Number	:	1780277665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA AMY HUTTON LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1327
Second Line	:
City	:	ORACLE
State	:	AZ
Zip	:	85623-1327
Country	:	US
Telephone Number	:	631-484-2763
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 W. BARBARA PL.
Second Line	:
City	:	ORACLE
State	:	AZ
Zip	:	85623
Country	:	US
Telephone Number	:	631-484-2763
Fax Number	:

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

Provider Enumeration Date	:	02/11/2021
Last Update Date	:	02/11/2021

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