MEDICARE: MS. MELONIE A TRUSLOW LCSW-C

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	16927	MD

General Provider Information

NPI Number	:	1790189918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELONIE A TRUSLOW LCSW-C

Provider Business Mailing Address
First Line	:	255 INLET DR
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-3147
Country	:	US
Telephone Number	:	443-591-1045
Fax Number	:	410-508-2041

Provider Business Practice Location Address
First Line	:	255 INLET DR
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-3147
Country	:	US
Telephone Number	:	443-591-1045
Fax Number	:	410-508-2041

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

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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