Provider Demographics
NPI:1679302368
Name:CIARAVINO, MEL (LLC)
Entity type:Individual
Prefix:
First Name:MEL
Middle Name:
Last Name:CIARAVINO
Suffix:
Gender:X
Credentials:LLC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:CIARAVINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20480 HUNT CLUB DR
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1740
Mailing Address - Country:US
Mailing Address - Phone:313-306-1160
Mailing Address - Fax:
Practice Address - Street 1:204 S MAIN ST UNIT 3
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MI
Practice Address - Zip Code:48818-9800
Practice Address - Country:US
Practice Address - Phone:313-306-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023772101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health