Provider Demographics
NPI:1598064735
Name:SHEA, MELISSA BERRYHILL (MSW, CCLS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BERRYHILL
Last Name:SHEA
Suffix:
Gender:F
Credentials:MSW, CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-4814
Mailing Address - Country:US
Mailing Address - Phone:916-396-7888
Mailing Address - Fax:
Practice Address - Street 1:1033 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-4814
Practice Address - Country:US
Practice Address - Phone:916-396-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist