Provider Demographics
NPI:1114768462
Name:DEMASKE, MELISSA ANN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:DEMASKE
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 1:108 STERLING AVE
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15461-1726
Mailing Address - Country:US
Mailing Address - Phone:724-366-6068
Mailing Address - Fax:
Practice Address - Street 1:201 BAKERS RIDGE RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1500
Practice Address - Country:US
Practice Address - Phone:304-598-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WVBP00942064104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator