Provider Demographics
NPI:1285704072
Name:ANTONES, MELANIE LEE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:LEE
Last Name:ANTONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:LEE
Other - Last Name:HEPPNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:885 FAIRFAX TER NW
Mailing Address - Street 2:
Mailing Address - City:PT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-3718
Mailing Address - Country:US
Mailing Address - Phone:786-521-1599
Mailing Address - Fax:
Practice Address - Street 1:140 JEFFERSON AVE #14006
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139
Practice Address - Country:US
Practice Address - Phone:786-521-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW63961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
6396Medicare UPIN