MEDICARE: MELISSA TAMAYO 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	110645	CA
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1578733804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA TAMAYO LCSW

Provider Business Mailing Address
First Line	:	200 E ANAHEIM ST
Second Line	:
City	:	WILMINGTON
State	:	CA
Zip	:	90744-4516
Country	:	US
Telephone Number	:	310-522-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E ANAHEIM ST
Second Line	:
City	:	WILMINGTON
State	:	CA
Zip	:	90744-4516
Country	:	US
Telephone Number	:	310-522-8700
Fax Number	:

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

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	05/29/2026

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