Provider Demographics
NPI:1518480730
Name:MELVILLE, TAYLOR BROOKE (PHD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BROOKE
Last Name:MELVILLE
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 1:115 MILL STREET
Mailing Address - Street 2:SOUTH BELKNAP BUILDING FLOOR 3
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 MILL STREET
Practice Address - Street 2:SOUTH BELKNAP BUILDING FLOOR 3
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478
Practice Address - Country:US
Practice Address - Phone:617-855-3660
Practice Address - Fax:617-855-3246
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30319103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical