Provider Demographics
NPI:1225456395
Name:CAVENECIA, MELISSA PAMELA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:PAMELA
Last Name:CAVENECIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 HYDE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5998
Mailing Address - Country:US
Mailing Address - Phone:925-644-0106
Mailing Address - Fax:
Practice Address - Street 1:815 HYDE ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5998
Practice Address - Country:US
Practice Address - Phone:415-673-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA898461041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical