Provider Demographics
NPI:1740309665
Name:MELBY, STEPHEN DEAN (LISW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DEAN
Last Name:MELBY
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 LAKEVIEW RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-6102
Mailing Address - Country:US
Mailing Address - Phone:505-452-0848
Mailing Address - Fax:505-452-0875
Practice Address - Street 1:1937 LAKEVIEW RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-6102
Practice Address - Country:US
Practice Address - Phone:505-452-0848
Practice Address - Fax:505-452-0875
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-049571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical