Provider Demographics
NPI:1487946851
Name:HARMDIERKS, MELISSA (MS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:HARMDIERKS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 HADDONFIELD RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-4813
Mailing Address - Country:US
Mailing Address - Phone:856-616-9442
Mailing Address - Fax:856-667-3563
Practice Address - Street 1:57 HADDONFIELD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-4813
Practice Address - Country:US
Practice Address - Phone:856-616-9442
Practice Address - Fax:856-667-3563
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8147103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst