Provider Demographics
NPI:1902624083
Name:BRIZZELL, MELISSA (MFT, MA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BRIZZELL
Suffix:
Gender:F
Credentials:MFT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3401
Mailing Address - Country:US
Mailing Address - Phone:215-416-9193
Mailing Address - Fax:
Practice Address - Street 1:1111 STREET RD STE 206
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4250
Practice Address - Country:US
Practice Address - Phone:215-953-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health