Provider Demographics
NPI:1750417739
Name:CARVALHO, MELVALINE
Entity type:Individual
Prefix:
First Name:MELVALINE
Middle Name:
Last Name:CARVALHO
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 1:35 JONATHAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2890
Mailing Address - Country:US
Mailing Address - Phone:508-823-1956
Mailing Address - Fax:
Practice Address - Street 1:4 POST OFFICE SQ
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3207
Practice Address - Country:US
Practice Address - Phone:508-823-5291
Practice Address - Fax:508-823-5906
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MARN160783364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health