MEDICARE: MELISSA GENISAUSKI LCSW

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	64699	CA

General Provider Information

NPI Number	:	1760838023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA GENISAUSKI LCSW

Provider Business Mailing Address
First Line	:	2525 E 19TH ST
Second Line	:	UNIT 22
City	:	SIGNAL HILL
State	:	CA
Zip	:	90755-6073
Country	:	US
Telephone Number	:	562-522-0432
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 OCEANGATE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4302
Country	:	US
Telephone Number	:	562-522-0432
Fax Number	:

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

Provider Enumeration Date	:	05/05/2016
Last Update Date	:	05/05/2016

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