Provider Demographics
NPI:1184809303
Name:HUTCHENS, MELANIE RUDY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:RUDY
Last Name:HUTCHENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:BETH
Other - Last Name:RUDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 MITCHELL BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903
Mailing Address - Country:US
Mailing Address - Phone:650-367-9610
Mailing Address - Fax:650-367-9612
Practice Address - Street 1:65 MITCHELL BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903
Practice Address - Country:US
Practice Address - Phone:650-367-9610
Practice Address - Fax:650-367-9612
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW-744051041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor