Individual provider Active NPI

Melanie Rudy Hutchens, LCSW

  • Clinical Social Worker
  • San Rafael, CA
National Provider Identifier
1184809303
Registry record updated Dec 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-74405 Issued in CA
Practice address
65 Mitchell Blvd
Suite 104
San Rafael, CA 94903
Phone
(650) 367-9610
Fax
(650) 367-9612
NPI assigned
Jan 7, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW-74405 CA Primary
Counselor 101Y00000X

Addresses

Primary practice location

65 Mitchell Blvd
Suite 104
San Rafael, CA 94903

Mailing address

65 Mitchell Blvd
Suite 104
San Rafael, CA 94903
Phone (650) 367-9610

Other names 1

  • Ms. Melanie Beth Rudy Former name

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LCSW-74405CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Community Services CurrentSince Dec 8, 2024 Accepting new patients

Locations

65 Mitchell Blvd
Ste 104
San Rafael, CA 94903
Phone (415) 275-1108

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733356800000",
    "number": "1184809303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 MITCHELL BLVD",
            "address_2": "SUITE 104",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "94903",
            "telephone_number": "650-367-9610",
            "fax_number": "650-367-9612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 MITCHELL BLVD",
            "address_2": "SUITE 104",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "94903",
            "telephone_number": "650-367-9610",
            "fax_number": "650-367-9612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUTCHENS",
        "first_name": "MELANIE",
        "middle_name": "RUDY",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-07",
        "last_updated": "2024-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW-74405",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELANIE",
            "last_name": "RUDY",
            "middle_name": "BETH",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.