Provider Demographics
NPI:1881672277
Name:FRODGE, MELISSA DIONE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DIONE
Last Name:FRODGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:DIONE
Other - Last Name:BARBALACO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4860 S CHAMPLAIN PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-4644
Mailing Address - Country:US
Mailing Address - Phone:520-429-6587
Mailing Address - Fax:
Practice Address - Street 1:5380 E KACHINA ST
Practice Address - Street 2:BLDG. 4220
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85707-4923
Practice Address - Country:US
Practice Address - Phone:520-228-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-116691041C0700X
AZLCSW-121231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical