MEDICARE: DR. MELISSA LEE BELANGER PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY-753	HI
2	103TC0700X	Clinical Psychologist	PSY 18864	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083635155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA LEE BELANGER PSYD

Provider Business Mailing Address
First Line	:	PO BOX 1451
Second Line	:
City	:	KAILUA
State	:	HI
Zip	:	96734-1451
Country	:	US
Telephone Number	:	808-247-7900
Fax Number	:	808-254-4526

Provider Business Practice Location Address
First Line	:	45-955 KAMEHAMEHA HWY STE 306
Second Line	:
City	:	KANEOHE
State	:	HI
Zip	:	96744-3292
Country	:	US
Telephone Number	:	808-247-7900
Fax Number	:	808-254-4526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	07/08/2007

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