Provider Demographics
NPI:1134668130
Name:POTTER, MELISSA M (LICSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:POTTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-1528
Mailing Address - Country:US
Mailing Address - Phone:603-767-3110
Mailing Address - Fax:
Practice Address - Street 1:55 MAIN ST STE 413
Practice Address - Street 2:
Practice Address - City:NEWMARKET
Practice Address - State:NH
Practice Address - Zip Code:03857-4201
Practice Address - Country:US
Practice Address - Phone:978-233-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH101YA0400X
NH24501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3137022Medicaid
NHNH3227Medicare PIN