Provider Demographics
NPI:1295886265
Name:PETERS, MELINDA JEAN (LCSW, BCD)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:JEAN
Last Name:PETERS
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 BONVUE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1103
Mailing Address - Country:US
Mailing Address - Phone:323-666-4270
Mailing Address - Fax:323-666-7054
Practice Address - Street 1:4770 BONVUE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-1103
Practice Address - Country:US
Practice Address - Phone:323-666-4270
Practice Address - Fax:323-666-7054
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0032151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical