Healthcare Provider Details

I. General information

NPI: 1780154484
Provider Name (Legal Business Name): MELISSA GAVAZZI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 WEST ST APT G
WEST HATFIELD MA
01088-9556
US

IV. Provider business mailing address

139 WEST ST APT G
WEST HATFIELD MA
01088-9556
US

V. Phone/Fax

Practice location:
  • Phone: 617-708-9554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: