Provider Demographics
NPI:1801177068
Name:MELNIK, YEVGENIYA KUTUZOVA (PSYD)
Entity type:Individual
Prefix:
First Name:YEVGENIYA
Middle Name:KUTUZOVA
Last Name:MELNIK
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 1:60 MARKET ST STE 213
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6559
Mailing Address - Country:US
Mailing Address - Phone:240-750-6467
Mailing Address - Fax:
Practice Address - Street 1:60 MARKET ST STE 213
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6559
Practice Address - Country:US
Practice Address - Phone:240-750-6467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103K00000X
MD06053103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD06053OtherPSYCHOLOGY LICENSE