MEDICARE: DR. MELODIE KAY MOOREHEAD PH.D.,ABPP

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	:	1992918148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELODIE KAY MOOREHEAD PH.D.,ABPP

Provider Business Mailing Address
First Line	:	1201 E BROWARD BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2133
Country	:	US
Telephone Number	:	954-444-1445
Fax Number	:	954-779-7994

Provider Business Practice Location Address
First Line	:	1201 E BROWARD BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2133
Country	:	US
Telephone Number	:	954-444-1445
Fax Number	:	954-779-7994

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/15/2021

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