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General NPI Number Information
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NPI Number | 1801320262
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Entity Type | Organization
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Legal Business Name | MELISSA DESSEREAU LLC
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 255 S 17TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19103-6231
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Country | US
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Telephone | 267-222-0851
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Fax |
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Provider Business Mailing Address
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Address Line | 434 LONGFELLOW RD
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City | WYNCOTE
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State | PA
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Zip | 19095-1913
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Country | US
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Telephone | 267-222-0851
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MELISSA SLABODA DESSEREAU
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Credential | LMFT
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Telephone | 267-222-0851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MF000928
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License Number State | PA
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