MEDICARE: MELANIE R CLEMONS PH.D.

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	103TF0000X	Family Psychologist	PSY 24578	CA
2	103TC2200X	Clinical Child & Adolescent Psychologist	PSY 24578	CA

General Provider Information

NPI Number	:	1841423332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE R CLEMONS PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 1051
Second Line	:
City	:	NEWARK
State	:	CA
Zip	:	94560-6051
Country	:	US
Telephone Number	:	510-982-6765
Fax Number	:

Provider Business Practice Location Address
First Line	:	470 27TH ST
Second Line	:	BAWAR
City	:	OAKLAND
State	:	CA
Zip	:	94612-2413
Country	:	US
Telephone Number	:	510-982-6765
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	07/15/2013

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