Healthcare Provider Details

I. General information

NPI: 1508367970
Provider Name (Legal Business Name): MELINDA MOTTA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 S ELM AVE
FRESNO CA
93706-5435
US

IV. Provider business mailing address

1120 E CHURCH AVE
FRESNO CA
93706
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-5200
  • Fax:
Mailing address:
  • Phone: 559-457-6970
  • Fax: 559-457-6995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number76631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: