Provider Demographics
NPI:1285372128
Name:KANENBLEY, MELISSA (MSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KANENBLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2371 SW 15TH ST APT 99
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7540
Mailing Address - Country:US
Mailing Address - Phone:561-779-0748
Mailing Address - Fax:754-227-7804
Practice Address - Street 1:2371 SW 15TH ST APT 99
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7540
Practice Address - Country:US
Practice Address - Phone:561-779-0748
Practice Address - Fax:754-227-7804
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW170961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical