Provider Demographics
NPI:1841613866
Name:VARGO, MELISSA KAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:KAY
Last Name:VARGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 MALUNIU AVE
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1944
Mailing Address - Country:US
Mailing Address - Phone:619-727-1287
Mailing Address - Fax:
Practice Address - Street 1:407 ULUNIU ST
Practice Address - Street 2:SUITE #412
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2519
Practice Address - Country:US
Practice Address - Phone:619-727-1287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1425103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool