Healthcare Provider Details

I. General information

NPI: 1841423332
Provider Name (Legal Business Name): MELANIE R CLEMONS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W WINTON AVE
HAYWARD CA
94544-1137
US

IV. Provider business mailing address

300 W WINTON AVE
HAYWARD CA
94544-1137
US

V. Phone/Fax

Practice location:
  • Phone: 510-293-7048
  • Fax: 510-293-7124
Mailing address:
  • Phone: 510-293-7048
  • Fax: 510-293-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY 24578
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 24578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: