Healthcare Provider Details

I. General information

NPI: 1477866465
Provider Name (Legal Business Name): MELISA OLIVA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 NW 9TH AVE SUITE 2416
MIAMI FL
33136-1409
US

IV. Provider business mailing address

1695 NW 9TH AVE SUITE 2416
MIAMI FL
33136-1409
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-7285
  • Fax: 305-355-8095
Mailing address:
  • Phone: 305-355-7285
  • Fax: 305-355-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberPY8747
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY8747
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY8747
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 8747
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9199
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: