Provider Demographics
NPI:1477844942
Name:DEL RIO, MELODIE LYNN (MFT)
Entity Type:Individual
Prefix:
First Name:MELODIE
Middle Name:LYNN
Last Name:DEL RIO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 IRVING ST # E
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2207
Mailing Address - Country:US
Mailing Address - Phone:415-710-8943
Mailing Address - Fax:
Practice Address - Street 1:946 IRVING ST # E
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2207
Practice Address - Country:US
Practice Address - Phone:415-710-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist