MEDICARE: LISA MELLACE LMHC

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	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	10628	MA

General Provider Information

NPI Number	:	1568834562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MELLACE LMHC

Provider Business Mailing Address
First Line	:	306 WASHINGTON ST STE 1
Second Line	:
City	:	NORWELL
State	:	MA
Zip	:	02061-1766
Country	:	US
Telephone Number	:	781-429-7755
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 WASHINGTON ST
Second Line	:
City	:	HANOVER
State	:	MA
Zip	:	02339-1675
Country	:	US
Telephone Number	:	781-678-8020
Fax Number	:

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

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	06/13/2024

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Directions to “ LISA MELLACE LMHC” Practice Location

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