Provider Demographics
NPI:1205583416
Name:NOONAN, MELISSA GRANT
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:GRANT
Last Name:NOONAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:BOURNE
Mailing Address - State:MA
Mailing Address - Zip Code:02532-3866
Mailing Address - Country:US
Mailing Address - Phone:724-462-9077
Mailing Address - Fax:
Practice Address - Street 1:1185 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-3066
Practice Address - Country:US
Practice Address - Phone:508-540-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health