Provider Demographics
NPI:1073948527
Name:LANDRY, MELINDA R (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:R
Last Name:LANDRY
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30207 FRANKFORD SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945
Mailing Address - Country:US
Mailing Address - Phone:302-732-3800
Mailing Address - Fax:302-732-6016
Practice Address - Street 1:30207 FRANKFORD SCHOOL RD
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:DE
Practice Address - Zip Code:19945-2616
Practice Address - Country:US
Practice Address - Phone:302-732-3800
Practice Address - Fax:302-732-6016
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE69427103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool