Healthcare Provider Details

I. General information

NPI: 1821476870
Provider Name (Legal Business Name): MELISSA HAYES LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W PARK ST STE 429
LEBANON NH
03766-6314
US

IV. Provider business mailing address

448 DANA RD
NORTH POMFRET VT
05053-5052
US

V. Phone/Fax

Practice location:
  • Phone: 802-243-0215
  • Fax:
Mailing address:
  • Phone: 802-243-0215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0134510
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2054
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: