Provider Demographics
NPI:1578833653
Name:NASCIMENTO, MELISSA S (LICSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:NASCIMENTO
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:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-0489
Mailing Address - Country:US
Mailing Address - Phone:508-254-9955
Mailing Address - Fax:
Practice Address - Street 1:361 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1637
Practice Address - Country:US
Practice Address - Phone:508-254-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118787171M00000X, 171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator