Active NPI
Gwendolyn Mellott, LCSWC
- Clinical Social Worker
- Hagerstown, MD
National Provider Identifier
1124094602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 10663
- Practice address
- 13215 Brook Lane
Hagerstown, MD 21742-1514 - Phone
- (301) 733-0331
- Fax
- (301) 733-4038
- NPI assigned
- Feb 24, 2006
- Sex
- Female
- 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 | 10663 | MD | Primary |
Addresses
Primary practice location
13215 Brook Lane
Hagerstown, MD 21742-1514
Mailing address
13121 Brook Lane
Hagerstown, MD 21742-1514
Phone (301) 733-0331
Other practice location 1
13218 Brook Lane Drive
Hagerstown, MD 21742
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
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10663 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519084800000",
"number": "1124094602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13121 BROOK LANE",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "217421514",
"telephone_number": "301-733-0331",
"fax_number": "301-733-4038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13215 BROOK LANE",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "217421514",
"telephone_number": "301-733-0331",
"fax_number": "301-733-4038"
}
],
"practiceLocations": [
{
"address_1": "13218 Brook Lane Drive",
"address_purpose": "LOCATION",
"city": "Hagerstown",
"state": "MD",
"postal_code": "21742",
"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": "GWENDOLYN",
"credential": "LCSWC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-24",
"last_updated": "2018-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "10663",
"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 Feb 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.