MEDICARE: MELISSA BURNETT 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
2	1041C0700X	Clinical Social Worker	89094	CA

General Provider Information

NPI Number	:	1780063602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA BURNETT LCSW

Provider Business Mailing Address
First Line	:	PO BOX 6282
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93539-6282
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 W LANCASTER BLVD # 62
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-3108
Country	:	US
Telephone Number	:	661-341-5198
Fax Number	:

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

Provider Enumeration Date	:	05/26/2015
Last Update Date	:	03/08/2023

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Directions to “ MELISSA BURNETT LCSW” Practice Location

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