Provider Demographics
NPI:1235448481
Name:HILLOCK, MELINDA ANN
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANN
Last Name:HILLOCK
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 1:312 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1408
Mailing Address - Country:US
Mailing Address - Phone:508-755-5322
Mailing Address - Fax:
Practice Address - Street 1:25 BOND STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-731-6095
Practice Address - Fax:413-788-4617
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1026179101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional