Provider Demographics
NPI:1497715981
Name:DEMENT, MELANIE R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:R
Last Name:DEMENT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PENACOOK RD
Mailing Address - Street 2:
Mailing Address - City:SANDOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03873-2149
Mailing Address - Country:US
Mailing Address - Phone:617-947-0883
Mailing Address - Fax:
Practice Address - Street 1:451 ANDOVER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5044
Practice Address - Country:US
Practice Address - Phone:617-947-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8205103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW51370Medicare ID - Type Unspecified