Healthcare Provider Details

I. General information

NPI: 1205121373
Provider Name (Legal Business Name): MELISSA L BELANGER PSYD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-955 KAMEHAMEHA HWY STE 306
KANEOHE HI
96744-3292
US

IV. Provider business mailing address

PO BOX 1451
KAILUA HI
96734-1451
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-7900
  • Fax: 808-254-4526
Mailing address:
  • Phone: 808-247-7900
  • Fax: 808-254-4526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberPSY 753
License Number StateHI

VIII. Authorized Official

Name: DR. MELISSA LEE BELANGER
Title or Position: PRESIDENT
Credential: PSYD
Phone: 808-247-7900