Provider Demographics
NPI:1891966727
Name:CAIN, MELINDA ROSE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:ROSE
Last Name:CAIN
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 1:223 SENECA LANE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:AZ
Mailing Address - Zip Code:85550
Mailing Address - Country:US
Mailing Address - Phone:928-475-7330
Mailing Address - Fax:928-475-7326
Practice Address - Street 1:223 SENECA LANE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:AZ
Practice Address - Zip Code:85550
Practice Address - Country:US
Practice Address - Phone:928-475-7330
Practice Address - Fax:928-475-7326
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25427104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker