Healthcare Provider Details

I. General information

NPI: 1003834367
Provider Name (Legal Business Name): MELINDA JANE BERGE ECHEVERRIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELINDA JANE BERGE

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/16/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W KATELLA AVE STE 150
ORANGE CA
92867-3432
US

IV. Provider business mailing address

1855 W KATELLA AVE STE 150
ORANGE CA
92867-3432
US

V. Phone/Fax

Practice location:
  • Phone: 714-399-3480
  • Fax:
Mailing address:
  • Phone: 714-399-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS23319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: