Provider Demographics
NPI:1417539636
Name:GREGORY, MELISSA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 WASHINGTON STREET
Mailing Address - Street 2:1202
Mailing Address - City:EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-5360
Mailing Address - Country:US
Mailing Address - Phone:781-801-4248
Mailing Address - Fax:508-532-1168
Practice Address - Street 1:244 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1147
Practice Address - Country:US
Practice Address - Phone:781-801-4248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA277247163W00000X, 363LP0808X, 364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health