Provider Demographics
NPI:1932156643
Name:MEISSNER, JUDITH HYDE (LICSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:HYDE
Last Name:MEISSNER
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 1:15 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01360-1105
Mailing Address - Country:US
Mailing Address - Phone:413-498-4343
Mailing Address - Fax:413-585-1376
Practice Address - Street 1:20 FEDERAL ST
Practice Address - Street 2:STE 2
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3324
Practice Address - Country:US
Practice Address - Phone:413-775-4715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10296081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO8225OtherBLUE CROSS/ BLUE SHIELD
MA1858998Medicaid
MA1858998Medicaid