Provider Demographics
NPI:1447316781
Name:GINNE, MELINDA (PHD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:
Last Name:GINNE
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:PO BOX 11117
Mailing Address - Street 2:280 W. MACARTHUR BLVD.
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-0117
Mailing Address - Country:US
Mailing Address - Phone:510-752-8302
Mailing Address - Fax:510-752-1553
Practice Address - Street 1:6355 TELEGRAPH AVE
Practice Address - Street 2:STE 302
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1374
Practice Address - Country:US
Practice Address - Phone:510-752-8302
Practice Address - Fax:510-752-1553
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15272103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL0152720Medicare ID - Type Unspecified