Provider Demographics
NPI:1245584705
Name:MELIA, AMANDA (BA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MELIA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 OCEAN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1232
Mailing Address - Country:US
Mailing Address - Phone:781-974-8078
Mailing Address - Fax:
Practice Address - Street 1:18 OCEAN VIEW DR
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1232
Practice Address - Country:US
Practice Address - Phone:781-974-8078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health