Healthcare Provider Details

I. General information

NPI: 1154187045
Provider Name (Legal Business Name): MELISSA ARDEN PLOURDE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 ARCH ST FL 17
BOSTON MA
02110-1424
US

IV. Provider business mailing address

244 BOULDER RD
BARNSTABLE MA
02630-1629
US

V. Phone/Fax

Practice location:
  • Phone: 857-505-2528
  • Fax:
Mailing address:
  • Phone: 508-414-8694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number313172
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: