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General NPI Number Information
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NPI Number | 1376823369
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Entity Type | Individual
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Provider Name | MELISSA ERIN TREVATHAN PHD
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Gender | Female
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 5209 YORK RD STE B12
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City | BALTIMORE
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State | MD
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Zip | 21212-4245
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Country | US
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Telephone | 410-532-2476
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 E LOMBARD ST
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City | BALTIMORE
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State | MD
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Zip | 21231-2021
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Country | US
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Telephone | 281-923-7308
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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