Provider Demographics
NPI:1255819090
Name:MELO, KACIE DAWN (LICSW)
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:DAWN
Last Name:MELO
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 1:1 TOWNE HILL RD
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01835
Mailing Address - Country:US
Mailing Address - Phone:978-478-8483
Mailing Address - Fax:
Practice Address - Street 1:BILLERICA MEMORIAL HIGH SCHOOL 35 RIVER ST
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821
Practice Address - Country:US
Practice Address - Phone:978-528-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120501101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool