Basic Information
| Provider Information | |||||||||
| NPI: | 1982378485 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MELISSA DIONNE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 ANNAPOLIS LN | ||||||||
| Address2: | |||||||||
| City: | PONTE VEDRA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320821512 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 121 ANNAPOLIS LN | ||||||||
| Address2: | |||||||||
| City: | PONTE VEDRA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320821512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046878377 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2021 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | PUTTERMAN | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8377904687 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | SW | ||||||||
| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.