Provider Demographics
NPI:1841400033
Name:WHITE, MELISSA A (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 NEPTUNE ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3563
Mailing Address - Country:US
Mailing Address - Phone:505-792-1669
Mailing Address - Fax:
Practice Address - Street 1:2400 LOUISIANA BLVD NE BLDG 5-700
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4396
Practice Address - Country:US
Practice Address - Phone:505-346-9539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-05511104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker