Provider Demographics
NPI:1538712690
Name:TODD, MELODY LOUISE (ASW)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:LOUISE
Last Name:TODD
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-1922
Mailing Address - Country:US
Mailing Address - Phone:925-708-2779
Mailing Address - Fax:
Practice Address - Street 1:2112 WILLOW PASS RD.
Practice Address - Street 2:SUITE 500
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520
Practice Address - Country:US
Practice Address - Phone:925-692-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW81596390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program