Provider Demographics
NPI:1801398102
Name:MELANSON, JANIS (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JANIS
Middle Name:
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:HIGGINS MIDDLE SCHOOL
Mailing Address - Street 2:85 PERKINS STREET
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960
Mailing Address - Country:US
Mailing Address - Phone:978-536-4895
Mailing Address - Fax:
Practice Address - Street 1:HIGGINS MIDDLE SCHOOL
Practice Address - Street 2:85 PERKINS STREET
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960
Practice Address - Country:US
Practice Address - Phone:978-536-4895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110484101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health