Provider Demographics
NPI:1679709414
Name:JAZEB, MELODY (LCSW, BCD)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:JAZEB
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SOUTH GLENDORA AVE #1391
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-2115
Mailing Address - Country:US
Mailing Address - Phone:626-873-1335
Mailing Address - Fax:
Practice Address - Street 1:26001 REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-7762
Practice Address - Country:US
Practice Address - Phone:626-873-1335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289591041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28959OtherLICENSED CLINICAL SOCIAL WORKER (LCSW)