Provider Demographics
NPI:1649778986
Name:MELO, ELIZABETH FRASER (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FRASER
Last Name:MELO
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 1:76 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3657
Mailing Address - Country:US
Mailing Address - Phone:617-320-5602
Mailing Address - Fax:
Practice Address - Street 1:27 PRESCOTT ST FL 2
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1903
Practice Address - Country:US
Practice Address - Phone:978-856-6135
Practice Address - Fax:978-458-3917
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1202121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical