Provider Demographics
NPI:1114465762
Name:JULES, MELISSA (MSW MED)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:JULES
Suffix:
Gender:F
Credentials:MSW MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 REGIS RD
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-1743
Mailing Address - Country:US
Mailing Address - Phone:857-399-6462
Mailing Address - Fax:
Practice Address - Street 1:1613 BLUE HILL AVE STE 304306
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2123
Practice Address - Country:US
Practice Address - Phone:857-399-6462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265EMedicaid