Healthcare Provider Details

I. General information

NPI: 1780697219
Provider Name (Legal Business Name): MELISSA BROOKE DAVID MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BELMONT ST
WORCESTER MA
01604-1675
US

IV. Provider business mailing address

20 MAIN ST STE 2D
LEOMINSTER MA
01453-5584
US

V. Phone/Fax

Practice location:
  • Phone: 508-421-4481
  • Fax:
Mailing address:
  • Phone: 508-421-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number213933
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114984
License Number StateMA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: