Provider Demographics
NPI:1306639513
Name:METAMORPHOSIS HEALTH, INC.-LICENSED CLINICAL SOCIAL WORKER, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:METAMORPHOSIS HEALTH, INC.-LICENSED CLINICAL SOCIAL WORKER, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVERA PASOQUEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CCTP
Authorized Official - Phone:925-701-1924
Mailing Address - Street 1:2150 PORTOLA AVE STE D188
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-1784
Mailing Address - Country:US
Mailing Address - Phone:925-701-1924
Mailing Address - Fax:
Practice Address - Street 1:2108 N ST STE N
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5712
Practice Address - Country:US
Practice Address - Phone:925-701-1924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health