Provider Demographics
NPI:1104848324
Name:STEIN, MELINDA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:B
Last Name:STEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E CHESAPEAKE AVE
Mailing Address - Street 2:202
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5338
Mailing Address - Country:US
Mailing Address - Phone:410-296-7424
Mailing Address - Fax:410-296-7424
Practice Address - Street 1:101 E CHESAPEAKE AVE
Practice Address - Street 2:202
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5338
Practice Address - Country:US
Practice Address - Phone:410-296-7424
Practice Address - Fax:410-296-7424
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1962103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG706Medicare ID - Type Unspecified
MDRO9393Medicare UPIN