Provider Demographics
NPI:1740505734
Name:DEVINCENTIS, MELISSA LYNNE (PHD, LMFT, BCBA)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LYNNE
Last Name:DEVINCENTIS
Suffix:
Gender:F
Credentials:PHD, LMFT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S ELMER AVE
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-2019
Mailing Address - Country:US
Mailing Address - Phone:607-221-5303
Mailing Address - Fax:
Practice Address - Street 1:203 S ELMER AVE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2019
Practice Address - Country:US
Practice Address - Phone:607-760-9520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-08-4739103K00000X
FL1-08-4739103K00000X
103K00000X
FLMT 2385106H00000X
PAMF000684106H00000X
PABH000092103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist