MEDICARE: LUCIANE LOUREIRO DE MELLO ASW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	32509	CA

General Provider Information

NPI Number	:	1023383965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIANE LOUREIRO DE MELLO ASW

Provider Business Mailing Address
First Line	:	51 E CAMPBELL AVE STE 106I
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-2054
Country	:	US
Telephone Number	:	408-375-0417
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 E CAMPBELL AVE STE 106I
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-2054
Country	:	US
Telephone Number	:	408-375-0417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2012
Last Update Date	:	06/10/2015

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