Provider Demographics
NPI:1023583374
Name:BASCOM, MELISSA K (LICSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:BASCOM
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:C/O CARE COORDINATION DEPARTMENT
Mailing Address - Street 2:1 ELLIOT WAY
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103
Mailing Address - Country:US
Mailing Address - Phone:603-663-2739
Mailing Address - Fax:603-663-2664
Practice Address - Street 1:C/O CARE COORDINATION DEPARTMENT
Practice Address - Street 2:1 ELLIOT WAY
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103
Practice Address - Country:US
Practice Address - Phone:603-663-2739
Practice Address - Fax:603-663-2664
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical