Provider Demographics
NPI:1043503410
Name:REMBA, EMILY MELISSA BRODIE (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MELISSA BRODIE
Last Name:REMBA
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 1:11440 W BERNARDO CT STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1644
Mailing Address - Country:US
Mailing Address - Phone:858-380-2600
Mailing Address - Fax:858-367-6160
Practice Address - Street 1:11440 W BERNARDO CT STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1644
Practice Address - Country:US
Practice Address - Phone:858-380-2600
Practice Address - Fax:858-367-6160
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA680291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health