Active NPI
Mellisa Marie Wilson, LCSW
- Social Worker
- McClellan, CA
National Provider Identifier
1033134523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LCS 22912
- Practice address
- 5342 Dudley Blvd
McClellan, CA 95652-1012 - Phone
- (916) 561-7708
- NPI assigned
- Jul 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LCS 22912 | CA | Primary |
Addresses
Primary practice location
5342 Dudley Blvd
McClellan, CA 95652-1012
Mailing address
5342 Dudley Blvd
McClellan, CA 95652-1012
Phone (916) 561-7708
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 22912 | CA | MD | Social Worker |
| 22912 | CA | MD | Certified Respiratory Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349913600000",
"number": "1033134523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5342 DUDLEY BLVD",
"city": "MCCLELLAN",
"state": "CA",
"postal_code": "956521012",
"telephone_number": "916-561-7708",
"fax_number": "916-501-8530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5342 DUDLEY BLVD",
"city": "MCCLELLAN",
"state": "CA",
"postal_code": "956521012",
"telephone_number": "916-561-7708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MELLISA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-13",
"last_updated": "2012-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "LCS 22912",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McClellan, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.