Healthcare Provider Details

I. General information

NPI: 1982936258
Provider Name (Legal Business Name): MARIBEL MELENDEZ MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 ELLEN ST APT 1R
CHICOPEE MA
01013-3061
US

IV. Provider business mailing address

19 ELLEN ST APT 1R
CHICOPEE MA
01013-3061
US

V. Phone/Fax

Practice location:
  • Phone: 413-363-3864
  • Fax:
Mailing address:
  • Phone: 413-363-3864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2068
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5493
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22600
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: