Provider Demographics
NPI:1851500532
Name:MOISAN, MELANIE J (LMHC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:MOISAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LORRAINE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1513
Mailing Address - Country:US
Mailing Address - Phone:617-755-5378
Mailing Address - Fax:
Practice Address - Street 1:661 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-5000
Practice Address - Country:US
Practice Address - Phone:617-755-5378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health