Provider Demographics
NPI:1366771644
Name:ROSERIE, MELANIE RENEE (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:RENEE
Last Name:ROSERIE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 MISSILE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MINOT AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58704
Mailing Address - Country:US
Mailing Address - Phone:701-723-5527
Mailing Address - Fax:
Practice Address - Street 1:194 MISSILE AVENUE
Practice Address - Street 2:MINOT AFB - 5 MDG MENTAL HEALTH CLINIC
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58705
Practice Address - Country:US
Practice Address - Phone:701-723-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD166951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical