MEDICARE: MRS. MELINDA ELIZABETH SOMERVILLE LISW-CP

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	6694	SC

General Provider Information

NPI Number	:	1881710580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELINDA ELIZABETH SOMERVILLE LISW-CP

Provider Business Mailing Address
First Line	:	1180 COLUMBIA AVE STE 203
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2890
Country	:	US
Telephone Number	:	803-407-0088
Fax Number	:	803-407-4457

Provider Business Practice Location Address
First Line	:	1180 COLUMBIA AVE STE 203
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2890
Country	:	US
Telephone Number	:	803-407-0088
Fax Number	:	803-407-4457

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	04/24/2018

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