Provider Demographics
NPI:1770720724
Name:RIDEOUT, MELISSA (PHD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:RIDEOUT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MORRISSEY BLVD
Mailing Address - Street 2:UMASS BOSTON UNIVERSITY HEALTH SERVICES
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3300
Mailing Address - Country:US
Mailing Address - Phone:617-287-5690
Mailing Address - Fax:617-287-3977
Practice Address - Street 1:100 MORRISSEY BLVD
Practice Address - Street 2:UMASS BOSTON UNIVERSITY HEALTH SERVICES
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-3300
Practice Address - Country:US
Practice Address - Phone:617-287-5690
Practice Address - Fax:617-287-3977
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8970103T00000X
NC3365103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist