Healthcare Provider Details

I. General information

NPI: 1184547218
Provider Name (Legal Business Name): MOONSTONE & MAPLE PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WORSTED ST
FRANKLIN MA
02038-3021
US

IV. Provider business mailing address

284 HARTFORD AVE
BELLINGHAM MA
02019-3000
US

V. Phone/Fax

Practice location:
  • Phone: 508-535-5863
  • Fax:
Mailing address:
  • Phone: 508-535-5863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. MARISSA MELNIKOV
Title or Position: OWNER
Credential: LICSW
Phone: 508-535-5863