Provider Demographics
NPI:1851621650
Name:SUMMERHAYES, MELANIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:SUMMERHAYES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 NORTHGATE DR STE 165
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2500
Mailing Address - Country:US
Mailing Address - Phone:510-838-2242
Mailing Address - Fax:
Practice Address - Street 1:1368 LINCOLN AVE
Practice Address - Street 2:STE 212
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2147
Practice Address - Country:US
Practice Address - Phone:510-838-2242
Practice Address - Fax:628-243-5703
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32252103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist