Provider Demographics
NPI:1427295096
Name:CAVENDER, MELISSA FAIRALL (MSW,LISW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:FAIRALL
Last Name:CAVENDER
Suffix:
Gender:F
Credentials:MSW,LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 WETHERBY LN STE A
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4957
Mailing Address - Country:US
Mailing Address - Phone:614-939-2308
Mailing Address - Fax:614-939-2309
Practice Address - Street 1:164 WETHERBY LN STE A
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4957
Practice Address - Country:US
Practice Address - Phone:614-939-2308
Practice Address - Fax:614-939-2309
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00051271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical