Provider Demographics
NPI:1205235074
Name:TERVET-DA CUNHA, MELISSA (MFT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:TERVET-DA CUNHA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PAUL DR STE E
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2047
Mailing Address - Country:US
Mailing Address - Phone:415-448-6456
Mailing Address - Fax:
Practice Address - Street 1:121 PAUL DR STE E
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2047
Practice Address - Country:US
Practice Address - Phone:415-448-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100732106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist