Provider Demographics
NPI:1578003315
Name:GOLDSMITH, MELISSA A (PHD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:GOLDSMITH
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 1:30505 BAINBRIDGE ROAD
Mailing Address - Street 2:SUITE 110-E
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2272
Mailing Address - Country:US
Mailing Address - Phone:440-306-3467
Mailing Address - Fax:
Practice Address - Street 1:30505 BAINBRIDGE ROAD
Practice Address - Street 2:SUITE 110-E
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2272
Practice Address - Country:US
Practice Address - Phone:440-306-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical