Provider Demographics
NPI:1417282963
Name:WEST, MELANIE (MA)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 N MEADOWS AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4012
Mailing Address - Country:US
Mailing Address - Phone:310-740-0014
Mailing Address - Fax:310-545-2561
Practice Address - Street 1:1505 N MEADOWS AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-4012
Practice Address - Country:US
Practice Address - Phone:310-740-0014
Practice Address - Fax:310-545-2561
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2612103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral