Provider Demographics
NPI:1942622147
Name:KLIKA MACK, MELISSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:KLIKA MACK
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 1:8 LONGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1712
Mailing Address - Country:US
Mailing Address - Phone:908-512-6027
Mailing Address - Fax:973-695-1483
Practice Address - Street 1:13 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1400
Practice Address - Country:US
Practice Address - Phone:908-512-6027
Practice Address - Fax:973-695-1483
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5134103TC0700X
NY019839103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical