Provider Demographics
NPI:1245438811
Name:MELKO, DIANA T (LCSW)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:T
Last Name:MELKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:T
Other - Last Name:THANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2008 MORSE AVE.
Mailing Address - Street 2:COMMON'S BUILDING
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2115
Mailing Address - Country:US
Mailing Address - Phone:916-973-4393
Mailing Address - Fax:
Practice Address - Street 1:2008 MORSE AVE.
Practice Address - Street 2:COMMON'S BLDNG
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2115
Practice Address - Country:US
Practice Address - Phone:916-973-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW205051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical