Healthcare Provider Details

I. General information

NPI: 1023372976
Provider Name (Legal Business Name): MELISSA JANE JADHAV LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 CHELSEA ST
EVERETT MA
02149-4632
US

IV. Provider business mailing address

PO BOX 2822
ACTON MA
01720-6822
US

V. Phone/Fax

Practice location:
  • Phone: 617-918-7242
  • Fax:
Mailing address:
  • Phone: 617-918-7242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8837
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: