Provider Demographics
NPI:1861550238
Name:GROEN, MELANIE KAY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:KAY
Last Name:GROEN
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 1:2045 COMPTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7286
Mailing Address - Country:US
Mailing Address - Phone:951-264-8754
Mailing Address - Fax:
Practice Address - Street 1:2045 COMPTON AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7286
Practice Address - Country:US
Practice Address - Phone:951-264-8754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 22295101YM0800X
CALCSW293501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health