Provider Demographics
NPI:1417567595
Name:MELISSA MCDORMAND LICSW, LLC
Entity Type:Organization
Organization Name:MELISSA MCDORMAND LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDORMAND
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-225-3430
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:MA
Mailing Address - Zip Code:01834-0097
Mailing Address - Country:US
Mailing Address - Phone:978-225-3430
Mailing Address - Fax:978-473-8883
Practice Address - Street 1:900 CUMMINGS CTR STE 416V
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6184
Practice Address - Country:US
Practice Address - Phone:978-225-3430
Practice Address - Fax:978-473-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty