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General NPI Number Information
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NPI Number | 1568593168
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Entity Type | Individual
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Provider Name | MELINDA GEREMILLO DRAKE LISW-CP AND AP, LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 42500 MORAGA RD APT 301
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City | TEMECULA
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State | CA
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Zip | 92591-4785
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Country | US
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Telephone | 803-331-0865
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Fax |
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Provider Business Mailing Address
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Address Line | 42500 MORAGA RD APT 301
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City | TEMECULA
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State | CA
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Zip | 92591-4785
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Country | US
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Telephone | 803-331-0865
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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 | 6042
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License Number State | SC
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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 | 68954
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License Number State | CA
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