Provider Demographics
NPI:1518564434
Name:ZIVANOV, MELISSA OLENA (MSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:OLENA
Last Name:ZIVANOV
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:OLENA
Other - Last Name:BONATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:140 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 S HOLLY ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3113
Practice Address - Country:US
Practice Address - Phone:908-337-0507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health