Healthcare Provider Details

I. General information

NPI: 1457255176
Provider Name (Legal Business Name): MELISSA CARNERO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 SW 15TH AVE
AMARILLO TX
79102-2519
US

IV. Provider business mailing address

1408 SW 15TH AVE
AMARILLO TX
79102-2519
US

V. Phone/Fax

Practice location:
  • Phone: 806-414-0068
  • Fax:
Mailing address:
  • Phone: 806-414-0068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number64996
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: