Provider Demographics
NPI:1548908106
Name:MELNICK, SAMANTHA ANNE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANNE
Last Name:MELNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1293 RED TAIL HAWK CT UNIT 5
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-8023
Mailing Address - Country:US
Mailing Address - Phone:814-694-8064
Mailing Address - Fax:
Practice Address - Street 1:2151 RUSH BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-1535
Practice Address - Country:US
Practice Address - Phone:330-744-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2202418-TRNE104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker