Provider Demographics
NPI:1932270337
Name:MELEY, KATHY DORIEN (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:DORIEN
Last Name:MELEY
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:HC 1 BOX 10
Mailing Address - Street 2:
Mailing Address - City:COOKSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16217-9704
Mailing Address - Country:US
Mailing Address - Phone:814-752-2979
Mailing Address - Fax:814-752-6456
Practice Address - Street 1:HC 1 BOX 10
Practice Address - Street 2:
Practice Address - City:COOKSBURG
Practice Address - State:PA
Practice Address - Zip Code:16217-9704
Practice Address - Country:US
Practice Address - Phone:814-752-2979
Practice Address - Fax:814-752-6456
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008292L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA705062Medicare ID - Type UnspecifiedPSYCHOLOGIST