Provider Demographics
NPI:1306203534
Name:HUNT, MELISSA G (PHD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:G
Last Name:HUNT
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 1:3720 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-6241
Mailing Address - Country:US
Mailing Address - Phone:215-898-6478
Mailing Address - Fax:215-898-7301
Practice Address - Street 1:3720 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-6241
Practice Address - Country:US
Practice Address - Phone:215-898-6478
Practice Address - Fax:215-898-7301
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009067L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical