Provider Demographics
NPI:1003047739
Name:MOORE, MELISA ENGLISH (PHD)
Entity type:Individual
Prefix:DR
First Name:MELISA
Middle Name:ENGLISH
Last Name:MOORE
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 MARENGO AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4818
Mailing Address - Country:US
Mailing Address - Phone:215-779-2611
Mailing Address - Fax:215-590-7387
Practice Address - Street 1:234 N EL MOLINO AVE STE 202
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-4404
Practice Address - Country:US
Practice Address - Phone:215-779-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025491103T00000X
OHP08567103T00000X
PAPS016465103TC0700X
CAPSY34185103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical