Provider Demographics
NPI:1477691947
Name:MORAN, MELANIE KNAPP (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:KNAPP
Last Name:MORAN
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 1:1547 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1342
Mailing Address - Country:US
Mailing Address - Phone:818-726-6360
Mailing Address - Fax:
Practice Address - Street 1:1547 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-1342
Practice Address - Country:US
Practice Address - Phone:818-726-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3457103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist