Provider Demographics
NPI:1790887479
Name:BARATTA, MELISSA CARRIE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:CARRIE
Last Name:BARATTA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:CARRIE
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2345
Mailing Address - Country:US
Mailing Address - Phone:508-435-2409
Mailing Address - Fax:
Practice Address - Street 1:409 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1741
Practice Address - Country:US
Practice Address - Phone:508-473-7400
Practice Address - Fax:508-473-6644
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10291161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23706Medicare ID - Type Unspecified