Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 35S100506000 | NJ |
NPI | 1003252610 |
---|---|
Provider Name | Dr. Melissa Acquavella-Lightfoot |
First Address | Marlton, NJ 08053-2172 |
Second Address | Marlton, NJ 08053-2172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2013 |
Last Update Date | 22/05/2013 |