Provider Demographics
NPI:1548539794
Name:SIERRA, MELANIE M (CADC II-CS)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:M
Last Name:SIERRA
Suffix:
Gender:F
Credentials:CADC II-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S. VICTORIA AVE
Mailing Address - Street 2:L#4615
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93009
Mailing Address - Country:US
Mailing Address - Phone:805-339-1122
Mailing Address - Fax:805-339-1128
Practice Address - Street 1:800 S. VICTORIA AVE
Practice Address - Street 2:L#4615
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93009
Practice Address - Country:US
Practice Address - Phone:805-339-1122
Practice Address - Fax:805-339-1128
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACATC 112919101YA0400X
CAAII053670318171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)