Provider Demographics
NPI:1801663224
Name:GEBREMEDHIN, MELAT
Entity type:Individual
Prefix:
First Name:MELAT
Middle Name:
Last Name:GEBREMEDHIN
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 1:24 HAMPDEN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-3290
Mailing Address - Country:US
Mailing Address - Phone:508-887-6949
Mailing Address - Fax:
Practice Address - Street 1:216 W BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1784
Practice Address - Country:US
Practice Address - Phone:508-213-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health