Provider Demographics
NPI:1649645664
Name:MELCHIORRE, JESSICA MARIE BOLGER (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE BOLGER
Last Name:MELCHIORRE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BOLGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:10332 JASON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-2628
Mailing Address - Country:US
Mailing Address - Phone:804-683-1114
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-4915
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004910103TC0700X
DCPSY1000914103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical