Provider Demographics
NPI:1285125476
Name:MELTON, SARAH ANITA
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANITA
Last Name:MELTON
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 1:770 LAKE COOK RD STE 320
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4976
Mailing Address - Country:US
Mailing Address - Phone:267-715-9681
Mailing Address - Fax:
Practice Address - Street 1:233 S 6TH ST STE C33
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3763
Practice Address - Country:US
Practice Address - Phone:267-715-9681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135712104100000X
NJ44SC060644001041C0700X
IL149.0250541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker