Provider Demographics
NPI:1891729273
Name:LONDON, MELODY D (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:D
Last Name:LONDON
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 1:920 SARATOGA AVE
Mailing Address - Street 2:SUITE 105B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3403
Mailing Address - Country:US
Mailing Address - Phone:408-247-1140
Mailing Address - Fax:408-247-1144
Practice Address - Street 1:920 SARATOGA AVE
Practice Address - Street 2:SUITE 105B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3403
Practice Address - Country:US
Practice Address - Phone:408-247-1140
Practice Address - Fax:408-247-1144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical