Provider Demographics
NPI:1013266071
Name:KUNIMATSU, MELISSA MIYUKI (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MIYUKI
Last Name:KUNIMATSU
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 1:644 N CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-4760
Mailing Address - Country:US
Mailing Address - Phone:248-909-2355
Mailing Address - Fax:504-383-6119
Practice Address - Street 1:644 N CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-4760
Practice Address - Country:US
Practice Address - Phone:248-909-2355
Practice Address - Fax:504-383-6119
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1398103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist