=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942638366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELISSA LIVNEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2013
-----------------------------------------------------
Last Update Date | 10/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1062 E LANCASTER AVE ST 15-H
-----------------------------------------------------
City | BRYN MAWR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19010-1552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-534-8815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 199
-----------------------------------------------------
City | PLYMOUTH MEETING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19462-0199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-534-8815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. MELISSA GARTENBERG LIVNEY
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 484-534-8815
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PS016641
-----------------------------------------------------
License Number State |
-----------------------------------------------------