Provider Demographics
NPI:1598070591
Name:FERNALD, MELISSA LYNN (LICSW, MLADC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LYNN
Last Name:FERNALD
Suffix:
Gender:F
Credentials:LICSW, MLADC
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 1464
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-1464
Mailing Address - Country:US
Mailing Address - Phone:603-569-4134
Mailing Address - Fax:603-569-4137
Practice Address - Street 1:35 CENTER ST
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4324
Practice Address - Country:US
Practice Address - Phone:603-569-5818
Practice Address - Fax:888-975-8097
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0816101YA0400X
NH1529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)