Healthcare Provider Details

I. General information

NPI: 1508045139
Provider Name (Legal Business Name): KEVIN J MELO MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALDRIN RD
PLYMOUTH MA
02360-4827
US

IV. Provider business mailing address

61 RAYMOND ST
FALMOUTH MA
02540-3666
US

V. Phone/Fax

Practice location:
  • Phone: 508-830-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: