Provider Demographics
NPI:1275844342
Name:MELVIN, MARY JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:MELVIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 PARADISE PARK RD
Mailing Address - Street 2:
Mailing Address - City:PEBBLE BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93953-2617
Mailing Address - Country:US
Mailing Address - Phone:831-649-1991
Mailing Address - Fax:831-649-1969
Practice Address - Street 1:140 W FRANKLIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2725
Practice Address - Country:US
Practice Address - Phone:831-649-1991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15328103TC0700X
CAMFC 23679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist