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General NPI Number Information
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NPI Number | 1669920468
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Entity Type | Individual
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Provider Name | VANESSA SHEA LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 2500 FAIRMONT DR FL 1
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City | SAN LEANDRO
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State | CA
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Zip | 94578-1005
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Country | US
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Telephone | 510-481-4135
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Fax |
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Provider Business Mailing Address
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Address Line | 248 3RD ST # 1100
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City | OAKLAND
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State | CA
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Zip | 94607-4375
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Country | US
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Telephone | 510-504-3167
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 112139
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License Number State | CA
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