Provider Demographics
NPI:1467100628
Name:WILLOUGHBY, MELODY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:
Last Name:WILLOUGHBY
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 1:307 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2626
Mailing Address - Country:US
Mailing Address - Phone:201-815-3801
Mailing Address - Fax:
Practice Address - Street 1:106 STRAUBE CENTER BLVD FL 5
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1449
Practice Address - Country:US
Practice Address - Phone:609-436-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00604400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist