Provider Demographics
NPI:1023071834
Name:SEASTEAD, MELISSA DUREI (LICSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DUREI
Last Name:SEASTEAD
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 1:416 BOSTON POST RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3016
Mailing Address - Country:US
Mailing Address - Phone:781-431-1177
Mailing Address - Fax:781-431-1181
Practice Address - Street 1:11 RIVER ST
Practice Address - Street 2:COLONY CARE BEHAVIORAL HEALTH
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2098
Practice Address - Country:US
Practice Address - Phone:781-431-1177
Practice Address - Fax:781-431-1181
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1106231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADUP22699Medicare ID - Type Unspecified