Provider Demographics
NPI:1982898748
Name:CHISARI-NOORI, MELISSA LEE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:CHISARI-NOORI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1867
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91358-1867
Mailing Address - Country:US
Mailing Address - Phone:805-795-2602
Mailing Address - Fax:
Practice Address - Street 1:101 HODENCAMP RD
Practice Address - Street 2:SUITE 114
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5836
Practice Address - Country:US
Practice Address - Phone:805-795-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23686103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical