Healthcare Provider Details

I. General information

NPI: 1922646777
Provider Name (Legal Business Name): MELISSA FLORES PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BEACON ST STE 209
BROOKLINE MA
02446-3202
US

IV. Provider business mailing address

1330 BEACON ST STE 209
BROOKLINE MA
02446-3202
US

V. Phone/Fax

Practice location:
  • Phone: 617-618-3026
  • Fax:
Mailing address:
  • Phone: 999-999-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10000637
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: