Provider Demographics
NPI:1669682480
Name:MELANSON, MARCIA PAIGE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:PAIGE
Last Name:MELANSON
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 316
Mailing Address - Street 2:274 MAIN STREET
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-0316
Mailing Address - Country:US
Mailing Address - Phone:978-448-0009
Mailing Address - Fax:
Practice Address - Street 1:274 MAIN ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1236
Practice Address - Country:US
Practice Address - Phone:978-448-0009
Practice Address - Fax:866-311-1832
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW104961-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA47139OtherTUFTS HEALTH PLAN
MA1056681OtherCIGNA
MA055746000OtherMAGELLANHEALTH
MA7998674OtherAETNA
MA505240OtherVALUE OPTIONS
MA1056681OtherCIGNA
MA47139OtherTUFTS HEALTH PLAN
MA7998674OtherAETNA
NHP03259Medicare UPIN
MAP03259Medicare ID - Type Unspecified