Healthcare Provider Details

I. General information

NPI: 1801717947
Provider Name (Legal Business Name): MELANIE PAIGE EDWARDS ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 FASHION LN STE 224
TUSTIN CA
92780-3355
US

IV. Provider business mailing address

350 MARINA DR APT 14
SEAL BEACH CA
90740-6037
US

V. Phone/Fax

Practice location:
  • Phone: 213-222-6553
  • Fax:
Mailing address:
  • Phone: 818-726-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number140050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: