Provider Demographics
NPI:1376843789
Name:MARCUS, MELISSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:MARCUS
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 1:12451 AVILES CIR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-8993
Mailing Address - Country:US
Mailing Address - Phone:561-249-2378
Mailing Address - Fax:
Practice Address - Street 1:12451 AVILES CIR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-8993
Practice Address - Country:US
Practice Address - Phone:561-249-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool