Provider Demographics
NPI:1912985862
Name:MELINKOFF, DONNA SIDNEY (MA, MFT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:SIDNEY
Last Name:MELINKOFF
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 S HACIENDA BLVD
Mailing Address - Street 2:SUITE 103-C
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4600
Mailing Address - Country:US
Mailing Address - Phone:626-330-7990
Mailing Address - Fax:626-855-5476
Practice Address - Street 1:2211 S HACIENDA BLVD
Practice Address - Street 2:SUITE 103-C
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-4600
Practice Address - Country:US
Practice Address - Phone:626-330-7990
Practice Address - Fax:626-855-5476
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25041106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist