Doctor Name: | DR. MELISSA ACQUAVELLA-LIGHTFOOT |
NPI Number: | 1003252610 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | 35S100506000 |
Business Practice Address: | 19 E Main St Marlton, NJ - 080532172 |
Business Phone Number: | 8569859091 |
Business Fax Number: | 8569859092 |
Mailing Address: | 19 E Main St, MARLTON |
State: | NJ |
Postal Code: | 080532172 |
Phone Number: | 8569859091 |
Fax Number: | 8569859092 |
NPI Enumeration Date: | 05/22/2013 |
NPI Last Update Date: | 05/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TB0200X |
License Number: | 35S100506000 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Cognitive & Behavioral |
Taxonomy Definition: |