Provider Demographics
NPI:1487730107
Name:MELENDEZ PALLITTO, MARTHA LAURA M (PSYD)
Entity type:Individual
Prefix:
First Name:MARTHA LAURA
Middle Name:M
Last Name:MELENDEZ PALLITTO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:LAURA
Other - Last Name:MELENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12012 WICKCHESTER LN
Mailing Address - Street 2:SUITE 550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1229
Mailing Address - Country:US
Mailing Address - Phone:832-448-2832
Mailing Address - Fax:832-448-2867
Practice Address - Street 1:12012 WICKCHESTER LN
Practice Address - Street 2:SUITE 550
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1229
Practice Address - Country:US
Practice Address - Phone:832-448-2832
Practice Address - Fax:832-448-2867
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33098103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical