Provider Demographics
NPI:1780689869
Name:BOSSERMAN, MELISSA R (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:R
Last Name:BOSSERMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 WEST ST
Mailing Address - Street 2:#206
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3869
Mailing Address - Country:US
Mailing Address - Phone:901-328-2110
Mailing Address - Fax:
Practice Address - Street 1:2176 WEST ST
Practice Address - Street 2:#206
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3869
Practice Address - Country:US
Practice Address - Phone:901-328-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC69161041C0700X
TN59141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical