Provider Demographics
NPI:1154498103
Name:SULFARO, MELISSA MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARIE
Last Name:SULFARO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 COOLIDGE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1693
Mailing Address - Country:US
Mailing Address - Phone:248-761-7949
Mailing Address - Fax:
Practice Address - Street 1:3250 COOLIDGE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1693
Practice Address - Country:US
Practice Address - Phone:248-761-7949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013065103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical