Provider Demographics
NPI:1144265851
Name:MELODY, JULIA WINSTON
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:WINSTON
Last Name:MELODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 FERGUSON RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-9642
Mailing Address - Country:US
Mailing Address - Phone:707-823-2374
Mailing Address - Fax:
Practice Address - Street 1:523 HAYES LN
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4011
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY143530Medicaid
CAPSY143530OtherCONTRA COSTA COUNTY
CAPSY143530OtherALAMEDA COUNTY
CA0PL143531Medicare ID - Type UnspecifiedSANTA CLARA
CAPSY143530OtherALAMEDA COUNTY
CAPSY143530OtherCONTRA COSTA COUNTY
CA0PL143531Medicare ID - Type UnspecifiedMARIN/NAPA/SOLANO COUNTY
CA0PL143531Medicare ID - Type UnspecifiedALL OTHER COUNTIES
CAPSY143530Medicaid