Healthcare Provider Details

I. General information

NPI: 1477221125
Provider Name (Legal Business Name): MELISSA MOONEY M.ED, LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 CHESTNUT ST
PHILADELPHIA PA
19107-4525
US

IV. Provider business mailing address

533 N BUDD ST
PHILADELPHIA PA
19104-1783
US

V. Phone/Fax

Practice location:
  • Phone: 215-650-8231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberBH007983
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-93300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: