Provider Demographics
NPI:1891164729
Name:DEL ROSARIO-MELENDEZ, NIRCIA R (LCSW)
Entity Type:Individual
Prefix:
First Name:NIRCIA
Middle Name:R
Last Name:DEL ROSARIO-MELENDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2114
Mailing Address - Country:US
Mailing Address - Phone:413-739-1100
Mailing Address - Fax:413-304-4666
Practice Address - Street 1:2155 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3301
Practice Address - Country:US
Practice Address - Phone:413-736-0395
Practice Address - Fax:413-734-1651
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2227351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110028120Medicaid
MAM21172OtherMEDICARE
MA1134107113OtherBEACON
MA1134107113OtherFALLON
MA1307576Medicaid
MA042622756OtherCCA
MA12529OtherHNE
MA1134107113OtherNHP
MA71756OtherTUFTS
MA997303OtherNETWORK HEALTH