Provider Demographics
NPI:1629123260
Name:TARGUM, MELISSA LAUREN (MED, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LAUREN
Last Name:TARGUM
Suffix:
Gender:F
Credentials:MED, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WATER ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-6051
Mailing Address - Country:US
Mailing Address - Phone:617-610-4123
Mailing Address - Fax:
Practice Address - Street 1:1968 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-1410
Practice Address - Country:US
Practice Address - Phone:781-292-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2138091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical