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General NPI Number Information
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NPI Number | 1790335636
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Entity Type | Individual
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Provider Name | MELISSA L HERCEG
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Gender | Female
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1555 SOQUEL DR
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1705
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Country | US
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Telephone | 831-840-5914
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Fax |
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Provider Business Mailing Address
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Address Line | 1555 SOQUEL DRIVE MATERNAL CHILD HEALTH SOCIAL WORKER
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1707
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Country | US
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Telephone | 831-840-5914
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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 | 90856
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License Number State | CA
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