MEDICARE: DR. MELISSA BERRENGE-BROWDE PSYCHOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	PSY11366	CA

General Provider Information

NPI Number	:	1003478405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA BERRENGE-BROWDE PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	820 BAY AVENUE, SUITE 205
Second Line	:
City	:	CAPITOLA
State	:	CA
Zip	:	95010-2102
Country	:	US
Telephone Number	:	831-462-0639
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 BAY AVENUE, SUITE 205
Second Line	:
City	:	CAPITOLA
State	:	CA
Zip	:	95010-2102
Country	:	US
Telephone Number	:	831-462-0639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2019
Last Update Date	:	07/05/2019

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