Provider Demographics
NPI:1376153718
Name:MELTON, GERMAINE (LMSW)
Entity Type:Individual
Prefix:
First Name:GERMAINE
Middle Name:
Last Name:MELTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:GERMAINE
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:9201 MONTGOMERY BLVD NE BLDG 5
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2468
Mailing Address - Country:US
Mailing Address - Phone:505-217-1717
Mailing Address - Fax:
Practice Address - Street 1:9201 MONTGOMERY BLVD NE BLDG 5
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2468
Practice Address - Country:US
Practice Address - Phone:505-217-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-11584104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
X-11584OtherLMSW