Provider Demographics
NPI:1861644635
Name:TROWBRIDGE, MELANIE M (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:M
Last Name:TROWBRIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MISSION BLVD
Mailing Address - Street 2:SUITE 2800
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2536
Mailing Address - Country:US
Mailing Address - Phone:209-257-0177
Mailing Address - Fax:209-257-0176
Practice Address - Street 1:100 MISSION BLVD
Practice Address - Street 2:SUITE 2800
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2536
Practice Address - Country:US
Practice Address - Phone:209-257-0177
Practice Address - Fax:209-257-0176
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78564103TP0016X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy