Provider Demographics
NPI:1316347743
Name:WATSON, MELODYE (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:MELODYE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 PELHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-1119
Mailing Address - Country:US
Mailing Address - Phone:301-910-1976
Mailing Address - Fax:
Practice Address - Street 1:2712 PELHAM AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1119
Practice Address - Country:US
Practice Address - Phone:301-910-1976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD193491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1578992525OtherHEALTHCARE PROVIDER ORGANIZATION NPI