Provider Demographics
NPI:1659819381
Name:MONTALVO, MELISSA LEIGH
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEIGH
Last Name:MONTALVO
Suffix:
Gender:
Credentials:
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:GOMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3901
Mailing Address - Country:US
Mailing Address - Phone:413-896-7099
Mailing Address - Fax:
Practice Address - Street 1:1 FEDERAL ST BLDG 102-3
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-2390
Practice Address - Country:US
Practice Address - Phone:413-737-9544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12379101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor