Provider Demographics
NPI:1386976330
Name:DAGOSTINO, MELANIE LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:LYNN
Last Name:DAGOSTINO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9711 CROSS PARK DRIVE
Mailing Address - Street 2:SUITE E475
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4533
Mailing Address - Country:US
Mailing Address - Phone:865-560-2570
Mailing Address - Fax:865-560-2580
Practice Address - Street 1:9111 CROSS PARK DR
Practice Address - Street 2:SUITE E 475
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4506
Practice Address - Country:US
Practice Address - Phone:865-560-2570
Practice Address - Fax:865-560-2580
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000077631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical