Basic Information
| Provider Information | |||||||||
| NPI: | 1760607998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | MELISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 EVERETT ST | ||||||||
| Address2: | UNIT 3 | ||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024531702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812091857 | ||||||||
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| Practice Location | |||||||||
| Address1: | 265 BEACH ST | ||||||||
| Address2: | |||||||||
| City: | REVERE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021513131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812899331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 213086 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.