Provider Demographics
NPI:1063380574
Name:MELINO, MARIS DANIELLE
Entity type:Individual
Prefix:
First Name:MARIS
Middle Name:DANIELLE
Last Name:MELINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 RIDGE AVE UNIT 31
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1065
Mailing Address - Country:US
Mailing Address - Phone:267-939-3538
Mailing Address - Fax:
Practice Address - Street 1:9001 RIDGE AVE UNIT 31
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1065
Practice Address - Country:US
Practice Address - Phone:267-939-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0266351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical