Provider Demographics
NPI:1215125901
Name:ESCOBAR, MELVIN L (LCSW)
Entity type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:L
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11487
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-0487
Mailing Address - Country:US
Mailing Address - Phone:510-788-0783
Mailing Address - Fax:
Practice Address - Street 1:2340 WARD ST STE 201
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1147
Practice Address - Country:US
Practice Address - Phone:510-788-0783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical