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NPI Code Detail

MEDICARE: MELISSA FAITH KELLY LCSW

MEDICARE: MELISSA FAITH KELLY 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
11041C0700XClinical Social WorkerCA

General Provider Information

NPI Number : 1962156919
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA FAITH KELLY LCSW
Provider Business Mailing Address
First Line : 2847 PETALUMA AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90815-1614
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2847 PETALUMA AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90815-1614
Country : US
Telephone Number : 562-631-5881
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2022
Last Update Date : 02/08/2022

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