Provider Demographics
NPI:1861581613
Name:STEVENS, MELISSA C (PSYD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:C
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:J
Other - Last Name:CHRISTINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYCHOLOGIST LPC
Mailing Address - Street 1:31 TANNER STREET
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033
Mailing Address - Country:US
Mailing Address - Phone:856-428-7646
Mailing Address - Fax:856-216-1839
Practice Address - Street 1:31 TANNER STREET
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033
Practice Address - Country:US
Practice Address - Phone:856-428-7646
Practice Address - Fax:856-216-1839
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00344300103T00000X
NJ#4703103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ170073Medicare UPIN