Provider Demographics
NPI:1427396456
Name:GUSHWA, MELINDA (PHD, MSW)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:
Last Name:GUSHWA
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MOUNT PLEASANT AVE
Mailing Address - Street 2:RHODE ISLAND COLLEGE SCHOOL OF SOCIAL WORK
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-1940
Mailing Address - Country:US
Mailing Address - Phone:401-456-8627
Mailing Address - Fax:
Practice Address - Street 1:1070 MAIN ST
Practice Address - Street 2:FELLOWSHIP BEHAVIORAL HEALTHCARE SERVICES
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4974
Practice Address - Country:US
Practice Address - Phone:401-721-5910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW014871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical