Active NPI
Melissa Ellison
- Clinical Social Worker
- Burlingame, CA
National Provider Identifier
1609252345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW82761
- Practice address
- 1501 Trousdale Dr
Burlingame, CA 94010-4506 - Phone
- (650) 652-8720
- NPI assigned
- Aug 5, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Mental Health Counselor | 101YM0800X | |||
| Clinical Social Worker | 1041C0700X | LCSW82761 | CA | Primary |
Addresses
Primary practice location
1501 Trousdale Dr
Burlingame, CA 94010-4506
Mailing address
325 Distel Cir
Los Altos, CA 94022-1408
Phone (650) 652-8720
Other practice location 1
2275 Arlington Dr
San Leandro, CA 94578-1132
Phone (510) 317-1444
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW82761 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sutter East Bay Medical Foundation | Past | Accepting new patients |
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.
-
- Family Medicine Physician
- Orinda, CA
- NPI 1871538769
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592870400000",
"number": "1609252345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 DISTEL CIR",
"city": "LOS ALTOS",
"state": "CA",
"postal_code": "940221408",
"telephone_number": "650-652-8720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 TROUSDALE DR",
"city": "BURLINGAME",
"state": "CA",
"postal_code": "940104506",
"telephone_number": "650-652-8720"
}
],
"practiceLocations": [
{
"address_1": "2275 Arlington Dr",
"address_purpose": "LOCATION",
"city": "San Leandro",
"state": "CA",
"postal_code": "945781132",
"country_code": "US",
"telephone_number": "510-317-1444",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ELLISON",
"first_name": "MELISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-05",
"last_updated": "2020-06-23",
"certification_date": "2020-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW82761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burlingame, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.