Provider Demographics
NPI:1467712422
Name:BASQUE, MELISSA RUTH (MED)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RUTH
Last Name:BASQUE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1406
Mailing Address - Country:US
Mailing Address - Phone:978-750-6976
Mailing Address - Fax:
Practice Address - Street 1:27 CONGRESS ST STE 105
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5577
Practice Address - Country:US
Practice Address - Phone:978-740-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health