Healthcare Provider Details

I. General information

NPI: 1750364766
Provider Name (Legal Business Name): MELINDA ANN KOHR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32828 REBA RD STE A
MILLVILLE DE
19967-6909
US

IV. Provider business mailing address

33316 HEAVENLY WAY STE 203
OCEAN VIEW DE
19970-3473
US

V. Phone/Fax

Practice location:
  • Phone: 302-567-1695
  • Fax: 302-616-3934
Mailing address:
  • Phone: 302-567-1695
  • Fax: 302-616-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY636
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: