Provider Demographics
NPI:1659449858
Name:NORTHROP, MELANIE G (LICSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:G
Last Name:NORTHROP
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 1:18 SAUNDERS TER
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5222
Mailing Address - Country:US
Mailing Address - Phone:781-235-3793
Mailing Address - Fax:
Practice Address - Street 1:1105 MASSACHUSETTS AVE APT 1G
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5207
Practice Address - Country:US
Practice Address - Phone:781-431-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1121101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANO P23548Medicare ID - Type Unspecified