Provider Demographics
NPI:1801983119
Name:MELERO, MARY ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:MELERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:ROTHENGASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:673 COTTAGE ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2419
Mailing Address - Country:US
Mailing Address - Phone:503-931-9523
Mailing Address - Fax:503-931-9523
Practice Address - Street 1:673 COTTAGE ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2419
Practice Address - Country:US
Practice Address - Phone:503-931-9523
Practice Address - Fax:503-931-9523
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR29781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical