Provider Demographics
NPI:1710280946
Name:CHASE, MELINDA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:
Last Name:CHASE
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 934
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-0934
Mailing Address - Country:US
Mailing Address - Phone:617-552-5124
Mailing Address - Fax:888-317-2641
Practice Address - Street 1:1100 WASHINGTON ST
Practice Address - Street 2:STE. 1
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1662
Practice Address - Country:US
Practice Address - Phone:617-552-5124
Practice Address - Fax:888-317-2641
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1159401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical