Healthcare Provider Details

I. General information

NPI: 1063846061
Provider Name (Legal Business Name): MELANIE SWAIN-KNAPP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MAN MAR DR SUITE 12
PLAINVILLE MA
02762-2271
US

IV. Provider business mailing address

14 GREENWOOD RD
CANTON MA
02021-3919
US

V. Phone/Fax

Practice location:
  • Phone: 774-203-9611
  • Fax: 508-316-0470
Mailing address:
  • Phone: 609-774-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW 117764
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. MELANIE SWAIN-KNAPP
Title or Position: THERAPIST
Credential: MSW, LICSW, MED
Phone: 609-774-3368