Provider Demographics
NPI:1366750416
Name:RANDOLPH, MELANIE LORENE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:LORENE
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 ST PATRICK WAY APT 510
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4885
Mailing Address - Country:US
Mailing Address - Phone:916-996-9119
Mailing Address - Fax:
Practice Address - Street 1:2255 YGNACIO VALLEY RD STE W
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3347
Practice Address - Country:US
Practice Address - Phone:925-406-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA819951041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program