Healthcare Provider Details

I. General information

NPI: 1891384087
Provider Name (Legal Business Name): MARISSA BROOKE MELNIKOV LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 WASHINGTON ST
NORWELL MA
02061-2010
US

IV. Provider business mailing address

284 HARTFORD AVE
BELLINGHAM MA
02019-3000
US

V. Phone/Fax

Practice location:
  • Phone: 781-871-6550
  • 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 Number128580
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: