Provider Demographics
NPI:1780003681
Name:MAROTE, MELISSA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:A
Last Name:MAROTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:22258 COVELLO ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1035
Mailing Address - Country:US
Mailing Address - Phone:740-541-0214
Mailing Address - Fax:
Practice Address - Street 1:22258 COVELLO ST
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1035
Practice Address - Country:US
Practice Address - Phone:740-541-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0002989101YM0800X
CALPCC922101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health