Provider Demographics
NPI:1952737322
Name:MELGAR, IVONNE JUDITH (LCSW)
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:JUDITH
Last Name:MELGAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8518 TWIN TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-5007
Mailing Address - Country:US
Mailing Address - Phone:650-504-8187
Mailing Address - Fax:650-504-8187
Practice Address - Street 1:2023 N ST STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-4240
Practice Address - Country:US
Practice Address - Phone:916-668-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA822781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical