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General NPI Number Information
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NPI Number | 1790801199
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Entity Type | Individual
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Provider Name | MELANIE H. MILDE LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 148 LINDEN ST STE 108
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City | WELLESLEY
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State | MA
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Zip | 02482-7916
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Country | US
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Telephone | 178-189-4432
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Fax |
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Provider Business Mailing Address
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Address Line | 148 LINDENT STREET SUITE 108
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City | WELLESLEY
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State | MA
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Zip | 02482
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Country | US
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Telephone | 617-291-1461
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Fax | 781-235-0713
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 213420
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License Number State | MA
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