Provider Demographics
NPI:1922188036
Name:MELTZ, JACKIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:
Last Name:MELTZ
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 1:5350 MANHATTAN CIR STE 237
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4272
Mailing Address - Country:US
Mailing Address - Phone:310-963-2541
Mailing Address - Fax:
Practice Address - Street 1:5350 MANHATTAN CIR STE 237
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4272
Practice Address - Country:US
Practice Address - Phone:310-963-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical