Provider Demographics
NPI:1902109036
Name:PEARL, MELANIE PUZA (PHD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:PUZA
Last Name:PEARL
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 1:38B GROVE ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4679
Mailing Address - Country:US
Mailing Address - Phone:203-505-4564
Mailing Address - Fax:
Practice Address - Street 1:38B GROVE ST STE 1A
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4679
Practice Address - Country:US
Practice Address - Phone:203-505-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016700103T00000X
NY018412103T00000X
CT003049103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist