MEDICARE: MELODY BREWER MSW

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	ASW 17220	CA

General Provider Information

NPI Number	:	1730238684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY BREWER MSW

Provider Business Mailing Address
First Line	:	1880 SHASTA ST
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-0417
Country	:	US
Telephone Number	:	530-248-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 ANTELOPE BLVD
Second Line	:	BUILDING B, SUITE 20
City	:	RED BLUFF
State	:	CA
Zip	:	96080-2474
Country	:	US
Telephone Number	:	530-248-3000
Fax Number	:	530-248-3098

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	01/23/2008

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