Provider Demographics
NPI:1215255021
Name:MCCOOL, MELISSA MARLENE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MARLENE
Last Name:MCCOOL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 HYGEIA AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2601
Mailing Address - Country:US
Mailing Address - Phone:760-815-0934
Mailing Address - Fax:
Practice Address - Street 1:534 HYGEIA AVE
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2601
Practice Address - Country:US
Practice Address - Phone:760-815-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical