Provider Demographics
NPI:1487993812
Name:SWEITZER, MELISSA (PHD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:SWEITZER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17853 SANTIAGO BLVD
Mailing Address - Street 2:#107-329
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-4113
Mailing Address - Country:US
Mailing Address - Phone:714-748-4440
Mailing Address - Fax:714-748-4445
Practice Address - Street 1:12443 LEWIS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4650
Practice Address - Country:US
Practice Address - Phone:714-748-4440
Practice Address - Fax:714-748-4445
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-04-1578103K00000X
CAPSY 10740103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist