Provider Demographics
NPI:1043484298
Name:MELAMED, LAWRENCE ERVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ERVIN
Last Name:MELAMED
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 FRANCES DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2811
Mailing Address - Country:US
Mailing Address - Phone:330-673-2986
Mailing Address - Fax:
Practice Address - Street 1:203 FRANCES DR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2811
Practice Address - Country:US
Practice Address - Phone:330-673-2986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1707103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist