Provider Demographics
NPI:1710337787
Name:EATON, MELODY RAE
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:RAE
Last Name:EATON
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 1:19 BUTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1005
Mailing Address - Country:US
Mailing Address - Phone:508-284-0577
Mailing Address - Fax:
Practice Address - Street 1:2143 HURLEY WAY
Practice Address - Street 2:STE 250
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3253
Practice Address - Country:US
Practice Address - Phone:916-922-9217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)