MEDICARE: MELODIE K MOOREHEAD, PHD, ABPP, PA

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	103TC0700X	Clinical Psychologist	PY4324	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	75811	OTHER	FL	BC/BS

General Provider Information

NPI Number	:	1467639898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELODIE K MOOREHEAD, PHD, ABPP, PA

Provider Business Mailing Address
First Line	:	1201 E BROWARD BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-2133
Country	:	US
Telephone Number	:	954-444-1445
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 E BROWARD BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-2133
Country	:	US
Telephone Number	:	954-444-1445
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MELODIE K MOOREHEAD
Credential	:	PHD
Telephone Number	:	954-444-1445

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	01/29/2008

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