Provider Demographics
NPI:1134281447
Name:AMAYA, MELIDA
Entity Type:Individual
Prefix:MS
First Name:MELIDA
Middle Name:
Last Name:AMAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 WESTVILLE ST
Mailing Address - Street 2:APT. # 1
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1415
Mailing Address - Country:US
Mailing Address - Phone:150-862-0010
Mailing Address - Fax:
Practice Address - Street 1:168 WESTVILLE ST
Practice Address - Street 2:APT. # 1
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1415
Practice Address - Country:US
Practice Address - Phone:150-862-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical