Provider Demographics
NPI:1982067534
Name:MEYER, MELISSA E (LMHC, ATR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:E
Last Name:MEYER
Suffix:
Gender:F
Credentials:LMHC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1732
Mailing Address - Country:US
Mailing Address - Phone:516-359-1151
Mailing Address - Fax:
Practice Address - Street 1:1570 WESTMINSTER ST
Practice Address - Street 2:#5
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1805
Practice Address - Country:US
Practice Address - Phone:516-359-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health