Provider Demographics
NPI:1447733415
Name:HERMAN, MELISSA (PSYD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:RESPLER-HERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:427 DAUB AVE
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1136
Mailing Address - Country:US
Mailing Address - Phone:917-679-1612
Mailing Address - Fax:
Practice Address - Street 1:427 DAUB AVE
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1136
Practice Address - Country:US
Practice Address - Phone:917-679-1612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5449103TC0700X
NY018771103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ47-3767975OtherTAX ID #