Provider Demographics
NPI:1164906038
Name:CARRIVEAU, MELISSA C (LICSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:C
Last Name:CARRIVEAU
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 1:269 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-3466
Mailing Address - Country:US
Mailing Address - Phone:413-592-6069
Mailing Address - Fax:413-598-8430
Practice Address - Street 1:269 MOORE ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-3466
Practice Address - Country:US
Practice Address - Phone:413-592-6069
Practice Address - Fax:413-598-8430
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1173481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical