Provider Demographics
NPI:1184355596
Name:MELISSA ROCKLEN LICSW, LLC
Entity type:Organization
Organization Name:MELISSA ROCKLEN LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-297-7695
Mailing Address - Street 1:97 WACHUSETT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4399
Mailing Address - Country:US
Mailing Address - Phone:617-501-6972
Mailing Address - Fax:
Practice Address - Street 1:97 WACHUSETT ST UNIT 1
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4399
Practice Address - Country:US
Practice Address - Phone:617-297-7695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health