Provider Demographics
NPI:1326124959
Name:ROBERTSON, MELISSA H (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:H
Last Name:ROBERTSON
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 1:7007 WASHINGTON AVE
Mailing Address - Street 2:SUITE 321
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1484
Mailing Address - Country:US
Mailing Address - Phone:562-696-3848
Mailing Address - Fax:562-696-9909
Practice Address - Street 1:7007 WASHINGTON AVE
Practice Address - Street 2:SUITE 321
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1484
Practice Address - Country:US
Practice Address - Phone:562-696-3848
Practice Address - Fax:562-696-9909
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11258103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP11258Medicare ID - Type Unspecified