Provider Demographics
NPI:1194856260
Name:HALL BOWSER, MELODEE (LICSW)
Entity Type:Individual
Prefix:
First Name:MELODEE
Middle Name:
Last Name:HALL BOWSER
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 1:304 STEERE FARM RD
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02830-1546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3123
Practice Address - Country:US
Practice Address - Phone:401-235-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW000581041C0700X
RI0581711041S0200X
MA1051291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool