Provider Demographics
NPI:1255895934
Name:CROWLEY, MELINDA BRAVO (PHD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:BRAVO
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:CROWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:472 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-2279
Mailing Address - Country:US
Mailing Address - Phone:617-529-4278
Mailing Address - Fax:
Practice Address - Street 1:75 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4960
Practice Address - Country:US
Practice Address - Phone:617-384-5869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9182103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling