Provider Demographics
NPI:1750364766
Name:KOHR, MELINDA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:ANN
Last Name:KOHR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33316 HEAVENLY WAY STE 203
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:DE
Mailing Address - Zip Code:19970-3473
Mailing Address - Country:US
Mailing Address - Phone:302-567-1695
Mailing Address - Fax:302-616-3934
Practice Address - Street 1:32828 REBA RD STE A
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6909
Practice Address - Country:US
Practice Address - Phone:302-567-1695
Practice Address - Fax:302-616-3934
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY636103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI113678753OtherTRICARE
HI113678753OtherALOHA CARE
HI113678753OtherHMAA
HI113678753OtherKAISER ADDED CHOICE
HI50138903Medicaid
HI00A0217719OtherHMSA QUEST
HI217075OtherHMA
HIA217719OtherHMSA
HIPSY636OtherQUEENS MEDICAL
HI55726Medicare ID - Type Unspecified