Provider Demographics
NPI:1982853909
Name:ERNOULD, MELANIE (PSYD)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:
Last Name:ERNOULD
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 1:2620 J ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4381
Mailing Address - Country:US
Mailing Address - Phone:612-910-7153
Mailing Address - Fax:
Practice Address - Street 1:2620 J ST STE 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4381
Practice Address - Country:US
Practice Address - Phone:612-910-7153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29035103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical