Provider Demographics
NPI:1295771319
Name:LONGWORTH-BEATTIE, MELANIE MAY (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:MAY
Last Name:LONGWORTH-BEATTIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:MAY
Other - Last Name:LONGWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:116 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5674
Mailing Address - Country:US
Mailing Address - Phone:586-465-4444
Mailing Address - Fax:586-783-2761
Practice Address - Street 1:116 MARKET ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5674
Practice Address - Country:US
Practice Address - Phone:586-465-4444
Practice Address - Fax:586-783-2761
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012761103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP108973050OtherBCBS INDIVIDUAL NUMBER
MIP108973050OtherBCBS INDIVIDUAL NUMBER