Healthcare Provider Details

I. General information

NPI: 1003355876
Provider Name (Legal Business Name): MELISSA WAXMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 BEAR TAVERN RD
EWING NJ
08628-1021
US

IV. Provider business mailing address

396 WASHINGTON ST # 266
WELLESLEY HILLS MA
02481-6209
US

V. Phone/Fax

Practice location:
  • Phone: 855-438-8331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP11806
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6418
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: