Provider Demographics
NPI:1871574475
Name:JOHNSON, MELANIE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MELANIE
Other - Middle Name:ANN
Other - Last Name:CAFFEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:522 BELVEDERE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-5627
Mailing Address - Country:US
Mailing Address - Phone:765-457-4253
Mailing Address - Fax:
Practice Address - Street 1:522 BELVEDERE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-5627
Practice Address - Country:US
Practice Address - Phone:765-457-4253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004095A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN231560Medicare ID - Type UnspecifiedLICENSED CLINICAL SOCIAL