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General NPI Number Information
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NPI Number | 1598215345
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Entity Type | Organization
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Legal Business Name | MELISSA MARCUS PH.D. PLC
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 8309 BANPO BRIDGE WAY
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City | DELRAY BEACH
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State | FL
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Zip | 33446-0029
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Country | US
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Telephone | 561-906-3691
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Fax |
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Provider Business Mailing Address
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Address Line | 8309 BANPO BRIDGE WAY
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City | DELRAY BEACH
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State | FL
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Zip | 33446-0029
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Country | US
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Telephone | 561-906-3691
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA MARCUS
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Credential | PHD
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Telephone | 561-906-3691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY8495
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License Number State | FL
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