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NPI Code Detail

MEDICARE: MS. MELANIE RAE DANGERFIELD LCSW

MEDICARE: MS. MELANIE RAE DANGERFIELD 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
1104100000XSocial Worker60632TX

General Provider Information

NPI Number : 1851078976
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MELANIE RAE DANGERFIELD LCSW
Provider Business Mailing Address
First Line : 428 CENTENNIAL PKWY
Second Line :
City : TYLER
State : TX
Zip : 75703-7166
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 428 CENTENNIAL PKWY
Second Line :
City : TYLER
State : TX
Zip : 75703-7166
Country : US
Telephone Number : 903-266-5900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2023
Last Update Date : 03/25/2026

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