MEDICARE: HAZEL LYNETTE MELMED 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	991346	CO

General Provider Information

NPI Number	:	1972642148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAZEL LYNETTE MELMED LCSW

Provider Business Mailing Address
First Line	:	1355 S COLORADO BLVD STE 100
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3310
Country	:	US
Telephone Number	:	303-756-9052
Fax Number	:	303-756-0308

Provider Business Practice Location Address
First Line	:	1355 S COLORADO BLVD STE 100
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3310
Country	:	US
Telephone Number	:	303-756-9052
Fax Number	:	303-756-0308

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	05/28/2010

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