MEDICARE: MR. JOHN LOUIS DEMELLO LCSW

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	1041C0700X	Clinical Social Worker	LCSW 4652	CA

General Provider Information

NPI Number	:	1033227558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN LOUIS DEMELLO LCSW

Provider Business Mailing Address
First Line	:	1006 SAN FRANCISCO CT
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-1441
Country	:	US
Telephone Number	:	510-532-8887
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 BELLEVUE AVE
Second Line	:	300
City	:	OAKLAND
State	:	CA
Zip	:	94610-4923
Country	:	US
Telephone Number	:	510-532-8887
Fax Number	:

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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