Provider Demographics
NPI:1144611468
Name:HARDEE, MELISSA ANN (BCABA)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:ANN
Last Name:HARDEE
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:4162 SW TUMBLE ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3145
Mailing Address - Country:US
Mailing Address - Phone:772-882-8671
Mailing Address - Fax:
Practice Address - Street 1:4162 SW TUMBLE ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3145
Practice Address - Country:US
Practice Address - Phone:850-521-0242
Practice Address - Fax:850-521-1973
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL0-14-6337103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst