Healthcare Provider Details

I. General information

NPI: 1093852279
Provider Name (Legal Business Name): MELANIE ELIZABETH MOPSICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 UNIVERSITY AVE SUITE 270
SACRAMENTO CA
95825-6513
US

IV. Provider business mailing address

455 UNIVERSITY AVE SUITE 270
SACRAMENTO CA
95825-6513
US

V. Phone/Fax

Practice location:
  • Phone: 916-568-1058
  • Fax: 916-487-7165
Mailing address:
  • Phone: 916-568-1058
  • Fax: 916-487-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCS18010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: