Provider Demographics
NPI:1992828933
Name:KLASKIN, MELISSA (PHD,LCSW)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:KLASKIN
Suffix:
Gender:F
Credentials:PHD,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S BEVERLY DR STE 107
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3800
Mailing Address - Country:US
Mailing Address - Phone:310-559-7315
Mailing Address - Fax:310-271-1781
Practice Address - Street 1:204 S BEVERLY DR STE 107
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3800
Practice Address - Country:US
Practice Address - Phone:310-559-7315
Practice Address - Fax:310-271-1781
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical