Provider Demographics
NPI:1265639751
Name:ABODEELY, MICHELLE F (MA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:F
Last Name:ABODEELY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ABODEELY
Other - Last Name:SMOLINSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:250 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3813
Mailing Address - Country:US
Mailing Address - Phone:831-427-3500
Mailing Address - Fax:831-427-1718
Practice Address - Street 1:250 LOCUST ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3813
Practice Address - Country:US
Practice Address - Phone:831-427-3500
Practice Address - Fax:831-427-1718
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD9958646OtherDRIVER'S LICENSE #