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General NPI Number Information
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NPI Number | 1366750416
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Entity Type | Individual
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Provider Name | MELANIE LORENE RANDOLPH MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 2255 YGNACIO VALLEY RD STE W
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City | WALNUT CREEK
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State | CA
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Zip | 94598-3347
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Country | US
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Telephone | 925-406-3208
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Fax |
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Provider Business Mailing Address
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Address Line | 7550 ST PATRICK WAY APT 510
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City | DUBLIN
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State | CA
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Zip | 94568-4885
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Country | US
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Telephone | 916-996-9119
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 81995
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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