Provider Demographics
NPI:1952350217
Name:FRIEDMAN, MELYSA IVY (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:MELYSA
Middle Name:IVY
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3160
Mailing Address - Country:US
Mailing Address - Phone:413-330-8761
Mailing Address - Fax:
Practice Address - Street 1:104 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3160
Practice Address - Country:US
Practice Address - Phone:413-330-8761
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1103791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAFR P22169Medicare ID - Type Unspecified