Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 14794 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 14794 | CA |
NPI | 1013064443 |
---|---|
Provider Name | Dr. Lucia M Melito |
First Address | Beverly Hills, CA 90212-4665 |
Second Address | Beverly Hills, CA 90212-4315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 14/12/2007 |