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General NPI Number Information
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NPI Number | 1184472946
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Entity Type | Individual
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Provider Name | SANDRA MELANY MARTHA LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/08/2024
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 3824 PENDIENTE CT APT 201
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City | SAN DIEGO
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State | CA
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Zip | 92124-3709
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Country | US
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Telephone | 619-207-6535
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 PALM AVE SPC 95
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City | SAN DIEGO
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State | CA
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Zip | 92154-1024
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Country | US
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Telephone | 619-207-6535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 250043002
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 120544
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License Number State | CA
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