Provider Demographics
NPI:1013392190
Name:CROSSMAN, MELINDA GREY (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:GREY
Last Name:CROSSMAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3157
Mailing Address - Country:US
Mailing Address - Phone:978-462-8611
Mailing Address - Fax:
Practice Address - Street 1:28 GREEN ST
Practice Address - Street 2:THE CARRIAGE HOUSE
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950
Practice Address - Country:US
Practice Address - Phone:978-270-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1169421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical