Provider Demographics
NPI:1487773305
Name:MELVIN, KASEY A (MA)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:A
Last Name:MELVIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 NEUSE BLVD
Mailing Address - Street 2:STE 5
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2815
Mailing Address - Country:US
Mailing Address - Phone:252-514-4770
Mailing Address - Fax:252-514-4773
Practice Address - Street 1:2807 NEUSE BLVD
Practice Address - Street 2:STE 5
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2815
Practice Address - Country:US
Practice Address - Phone:252-514-4770
Practice Address - Fax:252-514-4773
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2184103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent