MEDICARE: MS. MARCIA EMILY POST-MELCHISKEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1027742	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4743-01	OTHER	MA	PBH ID#
2	P08107	OTHER	MA	BCBSMA PROVIDER NUMBER

General Provider Information

NPI Number	:	1346326212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA EMILY POST-MELCHISKEY

Provider Business Mailing Address
First Line	:	26 ALBION ST
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02143-1103
Country	:	US
Telephone Number	:	857-928-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2464 MASS AVE
Second Line	:	SUITE #312A
City	:	CAMBRIDGE
State	:	MA
Zip	:	02140-1646
Country	:	US
Telephone Number	:	857-928-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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