Provider Demographics
NPI:1275182826
Name:MAXWELL-JUNGE, MELISSA KARA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KARA
Last Name:MAXWELL-JUNGE
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 1:215 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3405
Mailing Address - Country:US
Mailing Address - Phone:619-401-6305
Mailing Address - Fax:619-590-9036
Practice Address - Street 1:215 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3405
Practice Address - Country:US
Practice Address - Phone:619-401-6305
Practice Address - Fax:619-590-9036
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW907911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical