Provider Demographics
NPI:1821244229
Name:HSU, MELANIE VICTORIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:VICTORIA
Last Name:HSU
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 1:6620 VIA DEL ORO
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119
Mailing Address - Country:US
Mailing Address - Phone:408-360-2347
Mailing Address - Fax:
Practice Address - Street 1:6620 VIA DEL ORO
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1392
Practice Address - Country:US
Practice Address - Phone:408-360-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23914103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285628552OtherAGENCY NPI
NYWVE061OtherAGENCY MEDICARE ID
NY00355940OtherAGENCY MEDICAID ID