Provider Demographics
NPI:1154777464
Name:SWAIN-NEMBHARD, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SWAIN-NEMBHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:NEMBHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7550 DESERT HOLLY ST
Mailing Address - Street 2:APT 728
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-9380
Mailing Address - Country:US
Mailing Address - Phone:909-670-7910
Mailing Address - Fax:
Practice Address - Street 1:7550 DESERT HOLLY ST
Practice Address - Street 2:APT 728
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91708-9380
Practice Address - Country:US
Practice Address - Phone:909-670-7910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF83328106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist