Provider Demographics
NPI:1528184264
Name:ELSON, MELINDA DIANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:DIANE
Last Name:ELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:DIANE
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:172 E MIRA MONTE AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1225
Mailing Address - Country:US
Mailing Address - Phone:626-355-4223
Mailing Address - Fax:
Practice Address - Street 1:172 E MIRA MONTE AVE
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-1225
Practice Address - Country:US
Practice Address - Phone:626-355-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA196991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical