Healthcare Provider Details

I. General information

NPI: 1669922621
Provider Name (Legal Business Name): MELISSA MACALUSO BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 RIVERSIDE DR
MONROE LA
71201-6211
US

IV. Provider business mailing address

2305 BIENVILLE DR
MONROE LA
71201-2944
US

V. Phone/Fax

Practice location:
  • Phone: 318-398-0945
  • Fax: 318-398-4314
Mailing address:
  • Phone: 318-816-0247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: