Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1003415258 |
---|---|
Provider Name | Melissa Bangle |
First Address | Martinsburg, WV 25405-9991 |
Second Address | Martinsburg, WV 25405-9991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2020 |
Last Update Date | 20/10/2020 |