Provider Demographics
NPI:1225456395
Name:CAVENECIA, MELISSA PAMELA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:PAMELA
Last Name:CAVENECIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 CONTRA COSTA AVE APT J204
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-4073
Mailing Address - Country:US
Mailing Address - Phone:925-644-0106
Mailing Address - Fax:
Practice Address - Street 1:1330 CONTRA COSTA AVE APT J204
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-4073
Practice Address - Country:US
Practice Address - Phone:510-932-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89846104100000X, 1041C0700X
CA1286321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker