Provider Demographics
NPI:1376190215
Name:SMALL, MELISSA KERI (BACHELORS DEGREE)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KERI
Last Name:SMALL
Suffix:
Gender:F
Credentials:BACHELORS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 W 4TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2618
Mailing Address - Country:US
Mailing Address - Phone:781-812-8521
Mailing Address - Fax:
Practice Address - Street 1:7 CYPRESS DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4907
Practice Address - Country:US
Practice Address - Phone:781-328-0951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician