MEDICARE: ALYSSA J MELLOR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW007228	GA

General Provider Information

NPI Number	:	1548537095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA J MELLOR LCSW

Provider Business Mailing Address
First Line	:	301 BROADWAY
Second Line	:
City	:	CHELSEA
State	:	MA
Zip	:	02150-2807
Country	:	US
Telephone Number	:	617-912-7912
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 COLLIER RD NW APT 3118
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2575
Country	:	US
Telephone Number	:	207-319-2070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	02/29/2024

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