Provider Demographics
NPI:1235516634
Name:GOLDMAN, MELISSA NICOLE-FISHER (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:NICOLE-FISHER
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:FISHER GOLDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:305 N HARBOR BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1901
Mailing Address - Country:US
Mailing Address - Phone:714-584-8072
Mailing Address - Fax:
Practice Address - Street 1:305 N HARBOR BLVD STE 202
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1901
Practice Address - Country:US
Practice Address - Phone:714-584-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALSW 260771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical