Provider Demographics
NPI:1205336310
Name:MELLO, REBECCA (LICSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MELLO
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 1:393 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:393 E STATE ST
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:MA
Practice Address - Zip Code:01033-9601
Practice Address - Country:US
Practice Address - Phone:413-467-7198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool