Basic Information
| Provider Information | |||||||||
| NPI: | 1881810380 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3662 PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921034547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196924060 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12520 HIGH BLUFF DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921307002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582590599 | ||||||||
| FaxNumber: | 8587947218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS18331 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.