MEDICARE: MRS. MELLISSA MARIE DEPAOLA ASW

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18373	OTHER	CA	ASW

General Provider Information

NPI Number	:	1215088760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELLISSA MARIE DEPAOLA ASW

Provider Business Mailing Address
First Line	:	2001 CLUB CENTER DR APT 7107
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-1408
Country	:	US
Telephone Number	:	916-622-3002
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 AUBURN BLVD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-1831
Country	:	US
Telephone Number	:	916-483-2154
Fax Number	:

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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