Provider Demographics
NPI:1154467959
Name:SPORN, MELISSA BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:BETH
Last Name:SPORN
Suffix:
Gender:F
Credentials:PHD
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Other - First Name:
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Mailing Address - Street 1:1499 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5704
Mailing Address - Country:US
Mailing Address - Phone:703-288-9677
Mailing Address - Fax:703-388-2887
Practice Address - Street 1:1499 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5704
Practice Address - Country:US
Practice Address - Phone:703-288-9677
Practice Address - Fax:703-388-2887
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0810003407103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical