Provider Demographics
NPI:1932196201
Name:HARRISON, MELISSA (PSY D)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11555 HERON BAY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3362
Mailing Address - Country:US
Mailing Address - Phone:954-603-0077
Mailing Address - Fax:954-603-0401
Practice Address - Street 1:11555 HERON BAY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3362
Practice Address - Country:US
Practice Address - Phone:954-603-0077
Practice Address - Fax:954-603-0401
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5938103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6091ZMedicare PIN