Provider Demographics
NPI:1356457048
Name:DUBARD, MELANIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:DUBARD
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 1:3405 CIVIC CENTER BLVD
Mailing Address - Street 2:CHILD DEVELOPMENT & REHAB
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4302
Mailing Address - Country:US
Mailing Address - Phone:215-590-7555
Mailing Address - Fax:215-590-7387
Practice Address - Street 1:3440 MARKET ST
Practice Address - Street 2:SUITE 410
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3325
Practice Address - Country:US
Practice Address - Phone:215-590-7532
Practice Address - Fax:215-590-4251
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015996103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist