Provider Demographics
NPI:1326220872
Name:MELANSON, PAUL (LICSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MELANSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BOSTON MEDICAL CTR PL
Mailing Address - Street 2:EMERGENCY DEPT. BEST--DEPT OF PSYCHIATRY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2908
Mailing Address - Country:US
Mailing Address - Phone:617-414-4075
Mailing Address - Fax:617-414-1975
Practice Address - Street 1:85 E NEWTON ST
Practice Address - Street 2:5TH FLOOR-BEST
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2340
Practice Address - Country:US
Practice Address - Phone:617-414-2041
Practice Address - Fax:617-414-1975
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3033031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical