Provider Demographics
NPI:1598092066
Name:DE JONG, MELANIE J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:J
Last Name:DE JONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2933 B ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4936
Mailing Address - Country:US
Mailing Address - Phone:619-550-5534
Mailing Address - Fax:
Practice Address - Street 1:2933 B ST APT 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4936
Practice Address - Country:US
Practice Address - Phone:619-550-5534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000093231041C0700X
CALCS248441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical