Healthcare Provider Details

I. General information

NPI: 1497084008
Provider Name (Legal Business Name): ELIZABETH CHEYNE MELQUIST PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 GOLD STAR BLVD
WORCESTER MA
01606-2738
US

IV. Provider business mailing address

135 GOLD STAR BLVD
WORCESTER MA
01606-2738
US

V. Phone/Fax

Practice location:
  • Phone: 508-571-1609
  • Fax:
Mailing address:
  • Phone: 508-571-1609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9925
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: