MEDICARE: MELISSA L BELANGER PSYD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	PSY 753	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205121373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELISSA L BELANGER PSYD LLC

Provider Business Mailing Address
First Line	:	PO BOX 1451
Second Line	:
City	:	KAILUA
State	:	HI
Zip	:	96734-1451
Country	:	US
Telephone Number	:	808-247-7900
Fax Number	:	808-254-4526

Provider Business Practice Location Address
First Line	:	45-955 KAMEHAMEHA HWY STE 306
Second Line	:
City	:	KANEOHE
State	:	HI
Zip	:	96744-3292
Country	:	US
Telephone Number	:	808-247-7900
Fax Number	:	808-254-4526

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MELISSA LEE BELANGER
Credential	:	PSYD
Telephone Number	:	808-247-7900

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	06/16/2011

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