Provider Demographics
NPI:1023096930
Name:REARICK, MELLISSA J (LICSW)
Entity type:Individual
Prefix:
First Name:MELLISSA
Middle Name:J
Last Name:REARICK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:99 LINCOLN ST
Mailing Address - Street 2:CANCER CARE CENTER
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6327
Mailing Address - Country:US
Mailing Address - Phone:508-383-8529
Mailing Address - Fax:508-383-8584
Practice Address - Street 1:99 LINCOLN ST
Practice Address - Street 2:CANCER CARE CENTER
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6327
Practice Address - Country:US
Practice Address - Phone:508-383-8529
Practice Address - Fax:508-383-8584
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1131711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
92684OtherFALLON COMMUNITY HEALTH
042472266OtherTRICARE CHAMPUS
P23784OtherMEDICARE B
042472266OtherONE HEALTH PLAN