Provider Demographics
NPI:1831915255
Name:HUERTA, MELISSA FRASER (LCSW, PPSC)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:FRASER
Last Name:HUERTA
Suffix:
Gender:F
Credentials:LCSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8379 LA RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-1654
Mailing Address - Country:US
Mailing Address - Phone:916-764-9327
Mailing Address - Fax:
Practice Address - Street 1:8379 LA RIVIERA DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-1654
Practice Address - Country:US
Practice Address - Phone:916-764-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2001748631041S0200X
CA1274471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool