Provider Demographics
NPI:1023132446
Name:MELISSANO, RITA R (PHD, LFMT)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:R
Last Name:MELISSANO
Suffix:
Gender:F
Credentials:PHD, LFMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 UTICA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1626
Mailing Address - Country:US
Mailing Address - Phone:563-742-2050
Mailing Address - Fax:563-742-3505
Practice Address - Street 1:4622 PROGRESS DR
Practice Address - Street 2:STE 100
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3426
Practice Address - Country:US
Practice Address - Phone:563-742-5810
Practice Address - Fax:563-742-5800
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00028106H00000X
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist