Provider Demographics
NPI:1487393120
Name:MELISSA ACQUAVELLA-LIGHTFOOT, LLC
Entity type:Organization
Organization Name:MELISSA ACQUAVELLA-LIGHTFOOT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACQUAVELLA-LIGHTFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:856-210-9600
Mailing Address - Street 1:12 HASTINGS CT
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-5332
Mailing Address - Country:US
Mailing Address - Phone:917-647-2530
Mailing Address - Fax:
Practice Address - Street 1:30 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2002
Practice Address - Country:US
Practice Address - Phone:856-210-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty