Healthcare Provider Details

I. General information

NPI: 1063671170
Provider Name (Legal Business Name): MELANIE BELMONT M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 LEIMERT BLVD STE 200
OAKLAND CA
94602-1866
US

IV. Provider business mailing address

1425 LEIMERT BLVD STE 200
OAKLAND CA
94602-1866
US

V. Phone/Fax

Practice location:
  • Phone: 510-531-1383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC31187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: