Provider Demographics
NPI:1770665812
Name:MELLUSI, BEATRICE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:ANN
Last Name:MELLUSI
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 1:3635 CEDARBRAE LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-3255
Mailing Address - Country:US
Mailing Address - Phone:619-223-8001
Mailing Address - Fax:
Practice Address - Street 1:4550 KEARNY VILLA RD
Practice Address - Street 2:SUITE 116
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1578
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical