Provider Demographics
NPI:1174140735
Name:HANNA, MELISSA (BA PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:BA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 GOLF VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1015
Mailing Address - Country:US
Mailing Address - Phone:201-772-6450
Mailing Address - Fax:
Practice Address - Street 1:92 GOLF VIEW DR
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-1015
Practice Address - Country:US
Practice Address - Phone:201-772-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist