Provider Demographics
NPI:1750507554
Name:NABOR, MELINDA MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:MARIE
Last Name:NABOR
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 1:111 S GARFIELD AVE
Mailing Address - Street 2:SUITE #105
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3800
Mailing Address - Country:US
Mailing Address - Phone:323-728-1761
Mailing Address - Fax:
Practice Address - Street 1:111 S GARFIELD AVE
Practice Address - Street 2:SUITE #105
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3800
Practice Address - Country:US
Practice Address - Phone:323-728-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS194991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS015570Medicaid