Provider Demographics
NPI:1447589114
Name:SOUTHWORTH, MELISSA MORGAN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MORGAN
Last Name:SOUTHWORTH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 RIDGEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1698
Mailing Address - Country:US
Mailing Address - Phone:508-339-0904
Mailing Address - Fax:
Practice Address - Street 1:35 RIDGEVIEW LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1698
Practice Address - Country:US
Practice Address - Phone:508-339-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10244671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical