Provider Demographics
NPI:1114706470
Name:TATAR-PICKERSGILL, MELISSA (MS, LPC, NCC, BSP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:TATAR-PICKERSGILL
Suffix:
Gender:F
Credentials:MS, LPC, NCC, BSP
Other - Prefix:
Other - First Name:MSMISSYMS
Other - Middle Name:
Other - Last Name:TATAR-PICKERSGILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:115 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-2024
Mailing Address - Country:US
Mailing Address - Phone:267-577-1155
Mailing Address - Fax:
Practice Address - Street 1:25 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-7129
Practice Address - Country:US
Practice Address - Phone:267-797-5029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015535405300000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No405300000XOther Service ProvidersPrevention Professional