Provider Demographics
NPI:1770968109
Name:MELDON, SARA JESSICA GEISSER (PSYD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JESSICA GEISSER
Last Name:MELDON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:GEISSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5247 WISCONSIN AVE NW STE 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2012
Practice Address - Country:US
Practice Address - Phone:202-935-2452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCPSY1001331103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program