Provider Demographics
NPI:1215090600
Name:GREER G. MELIDONIS PSY.D. LLC
Entity type:Organization
Organization Name:GREER G. MELIDONIS PSY.D. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREER
Authorized Official - Middle Name:GRIERSON
Authorized Official - Last Name:MELIDONIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:908-359-2466
Mailing Address - Street 1:105 OMNI DR
Mailing Address - Street 2:CENTER FOR COLLABORATIVE PSYCHOLOGY, PA
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4512
Mailing Address - Country:US
Mailing Address - Phone:908-359-2466
Mailing Address - Fax:908-359-0746
Practice Address - Street 1:105 OMNI DR
Practice Address - Street 2:CENTER FOR COLLABORATIVE PSYCHOLOGY, PA
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4512
Practice Address - Country:US
Practice Address - Phone:908-359-2466
Practice Address - Fax:908-359-0746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI03317103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ122830Medicare UPIN