Provider Demographics
NPI:1174113450
Name:KUT, MELISSA (LSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:KUT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 BEAUMONT RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-3468
Mailing Address - Country:US
Mailing Address - Phone:717-817-0121
Mailing Address - Fax:
Practice Address - Street 1:2001 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2841
Practice Address - Country:US
Practice Address - Phone:717-774-1000
Practice Address - Fax:717-668-8353
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137540104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker