Provider Demographics
NPI:1467779686
Name:SLEGONA, MELISSA (LICSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SLEGONA
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 1:111 WASHINGTON STREET BOX 14
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762
Mailing Address - Country:US
Mailing Address - Phone:508-817-2524
Mailing Address - Fax:
Practice Address - Street 1:111 WASHINGTON ST
Practice Address - Street 2:STE 203
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2155
Practice Address - Country:US
Practice Address - Phone:508-817-2524
Practice Address - Fax:508-815-1605
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW016801041C0700X
MA1175381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical