Provider Demographics
NPI:1144413477
Name:GONDEK, MELISSA FAY (PHD)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:FAY
Last Name:GONDEK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:FAY
Other - Last Name:BUBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4055 E THOUSAND OAKS BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3600
Mailing Address - Country:US
Mailing Address - Phone:805-795-1238
Mailing Address - Fax:
Practice Address - Street 1:4055 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3600
Practice Address - Country:US
Practice Address - Phone:805-795-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23451103TC2200X, 103TB0200X, 103TP2701X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily