Provider Demographics
NPI:1568231595
Name:REDDY, MELANIE MARIE (LADC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MARIE
Last Name:REDDY
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CARLSON LN
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2534
Mailing Address - Country:US
Mailing Address - Phone:508-528-6080
Mailing Address - Fax:
Practice Address - Street 1:15 CARLSON LANE
Practice Address - Street 2:RELIEF RECOVERY
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02536
Practice Address - Country:US
Practice Address - Phone:508-528-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23208101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty