Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
Y | 103G00000X | Clinical Psychologist | 02536 | MD |
Y | 103TC0700X | Clinical Psychologist | 02536 | MD |
NPI | 1356542872 |
---|---|
Provider Name | Dr. Jacob I Melamed |
First Address | Bethesda, MD 20814-3002 |
Second Address | Bethesda, MD 20814-3002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 07/07/2010 |