Provider Demographics
NPI:1225287360
Name:MELENDEZ, EVELYN ROSARIO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:ROSARIO
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:EVELYN
Other - Middle Name:ROSARIO
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:747 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1859
Mailing Address - Country:US
Mailing Address - Phone:510-428-3484
Mailing Address - Fax:
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-604-7518
Practice Address - Fax:510-601-3912
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267281041C0700X
CALCS267281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical