Provider Demographics
NPI:1013064443
Name:MELITO, LUCIA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUCIA
Middle Name:M
Last Name:MELITO
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 1:333 S ELM DR
Mailing Address - Street 2:#103
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4665
Mailing Address - Country:US
Mailing Address - Phone:310-277-4063
Mailing Address - Fax:
Practice Address - Street 1:337 S BEVERLY DR
Practice Address - Street 2:212
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4315
Practice Address - Country:US
Practice Address - Phone:310-858-8117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14794103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical