Provider Demographics
NPI:1710165618
Name:GENEREAU, MELISSA MASI (LICSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MASI
Last Name:GENEREAU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:MASI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:46 JUSTINE RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-6239
Mailing Address - Country:US
Mailing Address - Phone:508-737-2169
Mailing Address - Fax:
Practice Address - Street 1:46 JUSTINE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-6239
Practice Address - Country:US
Practice Address - Phone:508-737-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213249101YM0800X
MA1182941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health