MEDICARE: MS. MELINDA CHASE LICSW

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	115940	MA

General Provider Information

NPI Number	:	1710280946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELINDA CHASE LICSW

Provider Business Mailing Address
First Line	:	PO BOX 934
Second Line	:
City	:	HANOVER
State	:	MA
Zip	:	02339-0934
Country	:	US
Telephone Number	:	617-552-5124
Fax Number	:	888-317-2641

Provider Business Practice Location Address
First Line	:	1100 WASHINGTON ST
Second Line	:	STE. 1
City	:	HANOVER
State	:	MA
Zip	:	02339-1662
Country	:	US
Telephone Number	:	617-552-5124
Fax Number	:	888-317-2641

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

Provider Enumeration Date	:	12/09/2010
Last Update Date	:	12/09/2010

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