MEDICARE: MELISSA PAMELA CAVENECIA

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	104100000X	Social Worker	89846	CA
2	1041C0700X	Clinical Social Worker	89846	CA
3	1041C0700X	Clinical Social Worker	128632	CA

General Provider Information

NPI Number	:	1225456395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA PAMELA CAVENECIA

Provider Business Mailing Address
First Line	:	1330 CONTRA COSTA AVE APT J204
Second Line	:
City	:	SAN PABLO
State	:	CA
Zip	:	94806-4073
Country	:	US
Telephone Number	:	925-644-0106
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 CONTRA COSTA AVE APT J204
Second Line	:
City	:	SAN PABLO
State	:	CA
Zip	:	94806-4073
Country	:	US
Telephone Number	:	510-932-6448
Fax Number	:

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

Provider Enumeration Date	:	04/04/2014
Last Update Date	:	03/18/2025

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Directions to “ MELISSA PAMELA CAVENECIA ” Practice Location

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