MEDICARE: MELISSA BRYANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LICSW121888	MA
2	1041C0700X	Clinical Social Worker	LCSW107616	CA

General Provider Information

NPI Number	:	1245713155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA BRYANT

Provider Business Mailing Address
First Line	:	1702 E BRIARVALE AVE
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92805-1311
Country	:	US
Telephone Number	:	707-592-7204
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 E BRIARVALE AVE
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92805-1311
Country	:	US
Telephone Number	:	707-592-7204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	04/21/2022

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Directions to “ MELISSA BRYANT ” Practice Location

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