Healthcare Provider Details

I. General information

NPI: 1952647513
Provider Name (Legal Business Name): MELISSA CRIPPEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2012
Last Update Date: 03/05/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 ATWOOD CT
EXETER CA
93221
US

IV. Provider business mailing address

247 ATWOOD CT
EXETER CA
93221
US

V. Phone/Fax

Practice location:
  • Phone: 559-666-0308
  • Fax:
Mailing address:
  • Phone: 559-666-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26508
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW26508
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: