Healthcare Provider Details

I. General information

NPI: 1346332855
Provider Name (Legal Business Name): MELANIE VIELHAUER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE VA BOSTON HEALTHCARE SYSTEM (116B)
BOSTON MA
02130-4817
US

IV. Provider business mailing address

150 S HUNTINGTON AVE
BOSTON MA
02130-4893
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-4043
  • Fax: 857-364-4408
Mailing address:
  • Phone: 857-364-4043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7298
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7298
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: