Provider Demographics
NPI:1982984480
Name:MACQUARRIE, MELYSSA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELYSSA
Middle Name:
Last Name:MACQUARRIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PAULARINO AVE
Mailing Address - Street 2:SUITE C-100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3301
Mailing Address - Country:US
Mailing Address - Phone:714-396-8037
Mailing Address - Fax:
Practice Address - Street 1:29900 GROUSE DR
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-5126
Practice Address - Country:US
Practice Address - Phone:714-396-8037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2022-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18134103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist