Provider Demographics
NPI:1497778831
Name:MELTZER, MARY-ELLEN (PMHCNS-BC)
Entity Type:Individual
Prefix:
First Name:MARY-ELLEN
Middle Name:
Last Name:MELTZER
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1432
Mailing Address - Country:US
Mailing Address - Phone:508-588-5782
Mailing Address - Fax:
Practice Address - Street 1:5 WALPOLE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3351
Practice Address - Country:US
Practice Address - Phone:781-255-8885
Practice Address - Fax:781-255-8883
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204029363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA409700OtherTUFTS
MAA006383OtherVALUE OPTIONS
PN0410OtherBLUE CROSS
MA131677000OtherMAGELLAN
MA131677000OtherMAGELLAN
S60790Medicare UPIN