Provider Demographics
NPI:1083635155
Name:BELANGER, MELISSA LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LEE
Last Name:BELANGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1451
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1451
Mailing Address - Country:US
Mailing Address - Phone:808-247-7900
Mailing Address - Fax:808-254-4526
Practice Address - Street 1:45-955 KAMEHAMEHA HWY STE 306
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3292
Practice Address - Country:US
Practice Address - Phone:808-247-7900
Practice Address - Fax:808-254-4526
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-753103TC0700X
CAPSY 18864103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55627701Medicaid
HIP90998Medicare UPIN
HI55534Medicare ID - Type Unspecified