Healthcare Provider Details

I. General information

NPI: 1801663224
Provider Name (Legal Business Name): MELAT GEBREMEDHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W BOYLSTON ST
WEST BOYLSTON MA
01583-1784
US

IV. Provider business mailing address

24 HAMPDEN ST APT 3
WORCESTER MA
01609-3290
US

V. Phone/Fax

Practice location:
  • Phone: 508-213-3355
  • Fax:
Mailing address:
  • Phone: 508-887-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: