Provider Demographics
NPI:1902394299
Name:GENN, MELISSA A (MS, LBS)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:A
Last Name:GENN
Suffix:
Gender:F
Credentials:MS, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4270 MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2513
Mailing Address - Country:US
Mailing Address - Phone:267-407-8282
Mailing Address - Fax:
Practice Address - Street 1:6122 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1603
Practice Address - Country:US
Practice Address - Phone:215-487-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling