Provider Demographics
NPI:1700664802
Name:DE MELLO, SIERRA JANE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SIERRA
Middle Name:JANE
Last Name:DE MELLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 21ST AVE E
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-4937
Mailing Address - Country:US
Mailing Address - Phone:208-358-3107
Mailing Address - Fax:
Practice Address - Street 1:2550 ADDISON AVE E STE G
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6748
Practice Address - Country:US
Practice Address - Phone:208-814-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID442460104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker