Provider Demographics
NPI:1831402262
Name:STARRETT, MELISSA (PSYD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:STARRETT
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 1:5173 WARING RD
Mailing Address - Street 2:PMB # 14
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2705
Mailing Address - Country:US
Mailing Address - Phone:858-208-3546
Mailing Address - Fax:
Practice Address - Street 1:450 A ST STE 500
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-4290
Practice Address - Country:US
Practice Address - Phone:858-208-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY29276103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program