Provider Demographics
NPI:1457786717
Name:MARIN, MELODY NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELODY
Middle Name:NICOLE
Last Name:MARIN
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 1:12306 KLONDIKE RUSH PT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-4024
Mailing Address - Country:US
Mailing Address - Phone:323-797-4589
Mailing Address - Fax:
Practice Address - Street 1:4444 W RIVERSIDE DR STE 397
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505
Practice Address - Country:US
Practice Address - Phone:818-252-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29249103T00000X
TX38786103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist