Provider Demographics
NPI:1467520395
Name:MELLO, CAROL JENNIFER (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JENNIFER
Last Name:MELLO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:JENNIFER
Other - Last Name:OLIVEIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:69 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346
Mailing Address - Country:US
Mailing Address - Phone:508-717-4706
Mailing Address - Fax:
Practice Address - Street 1:801 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3052
Practice Address - Country:US
Practice Address - Phone:508-586-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health