MEDICARE: STARLIGHT MELODY GARCIA LCSW

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	1041C0700X	Clinical Social Worker	29501	CA
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1427177682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STARLIGHT MELODY GARCIA LCSW

Provider Business Mailing Address
First Line	:	13627 KALNOR AVE
Second Line	:
City	:	NORWALK
State	:	CA
Zip	:	90650-4023
Country	:	US
Telephone Number	:	323-304-8726
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 S VERMONT AVE FL 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3493
Country	:	US
Telephone Number	:	213-924-0616
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	01/19/2021

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