Healthcare Provider Details

I. General information

NPI: 1881810380
Provider Name (Legal Business Name): MELANIE ANNE ROSS L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12520 HIGH BLUFF DR STE 120
SAN DIEGO CA
92130-7002
US

IV. Provider business mailing address

3662 PARK BLVD
SAN DIEGO CA
92103-4547
US

V. Phone/Fax

Practice location:
  • Phone: 858-259-0599
  • Fax: 858-794-7218
Mailing address:
  • Phone: 619-692-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS18331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: