Provider Demographics
NPI:1629138037
Name:ROSE, MELISSA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LYNN
Last Name:ROSE
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 1:2829 WATT AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6237
Mailing Address - Country:US
Mailing Address - Phone:916-482-1132
Mailing Address - Fax:916-979-3503
Practice Address - Street 1:2829 WATT AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-6237
Practice Address - Country:US
Practice Address - Phone:916-482-1132
Practice Address - Fax:916-979-3503
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical