Provider Demographics
NPI:1508020520
Name:JOHNSON CARCICH, MELINDA SUE (MA LMFT44024)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:JOHNSON CARCICH
Suffix:
Gender:F
Credentials:MA LMFT44024
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6529 CROWN BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120
Mailing Address - Country:US
Mailing Address - Phone:408-975-2991
Mailing Address - Fax:408-997-0711
Practice Address - Street 1:6529 CROWN BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120
Practice Address - Country:US
Practice Address - Phone:408-975-2991
Practice Address - Fax:408-997-0711
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44024106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist