Provider Demographics
NPI:1811169618
Name:MISHCON, MELISSA E (MS - REHABILITATION)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:E
Last Name:MISHCON
Suffix:
Gender:F
Credentials:MS - REHABILITATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:MA
Mailing Address - Zip Code:01245-0063
Mailing Address - Country:US
Mailing Address - Phone:413-528-1661
Mailing Address - Fax:
Practice Address - Street 1:617 MAIN RD
Practice Address - Street 2:BOX 63
Practice Address - City:MONTEREY
Practice Address - State:MA
Practice Address - Zip Code:01245-9732
Practice Address - Country:US
Practice Address - Phone:413-528-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMH RT 1115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health