Provider Demographics
NPI:1396767547
Name:CONTI, MELISSA (PSYD, RD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CONTI
Suffix:
Gender:F
Credentials:PSYD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 N PARK RD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2912
Mailing Address - Country:US
Mailing Address - Phone:610-375-0544
Mailing Address - Fax:610-378-9779
Practice Address - Street 1:716 N PARK RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2912
Practice Address - Country:US
Practice Address - Phone:610-375-0544
Practice Address - Fax:610-378-9779
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015708103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098089K34Medicare PIN