Provider Demographics
NPI:1962788174
Name:MONDICH, MELISSA GRACE (LCSW-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GRACE
Last Name:MONDICH
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:GRACE
Other - Last Name:ENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6565 N. CHARLES STREET
Mailing Address - Street 2:PPE-203
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:443-849-3760
Mailing Address - Fax:443-849-8138
Practice Address - Street 1:6565 N. CHARLES STREET
Practice Address - Street 2:PPE-203
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:443-849-3760
Practice Address - Fax:443-849-8138
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD204271041C0700X
NCC0074831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical