Healthcare Provider Details

I. General information

NPI: 1184809303
Provider Name (Legal Business Name): MELANIE RUDY HUTCHENS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MELANIE BETH RUDY

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 12/05/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MITCHELL BLVD SUITE 104
SAN RAFAEL CA
94903
US

IV. Provider business mailing address

65 MITCHELL BLVD SUITE 104
SAN RAFAEL CA
94903
US

V. Phone/Fax

Practice location:
  • Phone: 650-367-9610
  • Fax: 650-367-9612
Mailing address:
  • Phone: 650-367-9610
  • Fax: 650-367-9612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-74405
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: