Provider Demographics
NPI:1205121373
Name:MELISSA L BELANGER PSYD LLC
Entity type:Organization
Organization Name:MELISSA L BELANGER PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-247-7900
Mailing Address - Street 1:PO BOX 1451
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1451
Mailing Address - Country:US
Mailing Address - Phone:808-247-7900
Mailing Address - Fax:808-254-4526
Practice Address - Street 1:45-955 KAMEHAMEHA HWY STE 306
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3292
Practice Address - Country:US
Practice Address - Phone:808-247-7900
Practice Address - Fax:808-254-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 753261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55627701Medicaid
HIP90998Medicare UPIN
HI55534Medicare PIN