Healthcare Provider Details

I. General information

NPI: 1215070016
Provider Name (Legal Business Name): MELISSA BURROUGHS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E FOOTHILL BLVD
PASADENA CA
91107-3406
US

IV. Provider business mailing address

2550 E FOOTHILL BLVD
PASADENA CA
91107-3406
US

V. Phone/Fax

Practice location:
  • Phone: 626-744-5230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: