Provider Demographics
NPI:1578791182
Name:JEAN-CHARLES, MELISSA ANTOINETTE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANTOINETTE
Last Name:JEAN-CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CEDARCREST AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4341
Mailing Address - Country:US
Mailing Address - Phone:781-929-1332
Mailing Address - Fax:
Practice Address - Street 1:1 ARNOLD CIR STE 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-2250
Practice Address - Country:US
Practice Address - Phone:781-929-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2156741041C0700X
MA1164591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical