Provider Demographics
NPI:1669725982
Name:HAMLETT, MELISSA KIM (LICSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KIM
Last Name:HAMLETT
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 1:194 CENTER HILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LANDAFF
Mailing Address - State:NH
Mailing Address - Zip Code:03585-5202
Mailing Address - Country:US
Mailing Address - Phone:603-496-2852
Mailing Address - Fax:
Practice Address - Street 1:194 CENTER HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:LANDAFF
Practice Address - State:NH
Practice Address - Zip Code:03585-5202
Practice Address - Country:US
Practice Address - Phone:603-496-2852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1022861OtherMEDICAID
NH3087986Medicaid