Provider Demographics
NPI:1033307327
Name:DAVIS, MELANIE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8339 CHURCH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4450
Mailing Address - Country:US
Mailing Address - Phone:408-430-3803
Mailing Address - Fax:
Practice Address - Street 1:8339 CHURCH ST STE 109
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4450
Practice Address - Country:US
Practice Address - Phone:408-430-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical