Active NPI
Stephen Mellott, LCSWC
- Clinical Social Worker
- Hagerstown, MD
National Provider Identifier
1083680359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 10489
- Practice address
- 10435 Downsville Pike
Hagerstown, MD 21740-1732 - Phone
- (301) 766-8423
- NPI assigned
- Feb 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 10489 | MD | Primary |
Addresses
Primary practice location
10435 Downsville Pike
Hagerstown, MD 21740-1732
Mailing address
10435 Downsville Pike
Hagerstown, MD 21740-1732
Phone (301) 766-8423
Other practice location 1
13218 Brooklane Drive
Hagerstown, MD 21742-1945
Phone (301) 733-0331 ext. 184
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 986965400 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10489 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545264000000",
"number": "1083680359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10435 DOWNSVILLE PIKE",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "217401732",
"telephone_number": "301-766-8423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10435 DOWNSVILLE PIKE",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "217401732",
"telephone_number": "301-766-8423"
}
],
"practiceLocations": [
{
"address_1": "13218 Brooklane Drive",
"address_purpose": "LOCATION",
"city": "Hagerstown",
"state": "MD",
"postal_code": "217421945",
"country_code": "US",
"telephone_number": "301-733-0331 x184",
"fax_number": "301-733-4038",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MELLOTT",
"first_name": "STEPHEN",
"credential": "LCSWC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-27",
"last_updated": "2018-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "10489",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "986965400",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hagerstown, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.