Provider Demographics
NPI:1154916690
Name:MELERSKI, JENNIFER E (PSYD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:MELERSKI
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:PO BOX 1600
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-1600
Mailing Address - Country:US
Mailing Address - Phone:336-264-4827
Mailing Address - Fax:919-869-2228
Practice Address - Street 1:608 EVERGLADES DR
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-7167
Practice Address - Country:US
Practice Address - Phone:336-264-4827
Practice Address - Fax:919-869-2228
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical