MEDICARE: SHEILA HELEN DEMELLE 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	1026645	MA

General Provider Information

NPI Number	:	1942533450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA HELEN DEMELLE LICSW

Provider Business Mailing Address
First Line	:	1032 TURNPIKE ST
Second Line	:	SUITE 204
City	:	CANTON
State	:	MA
Zip	:	02021-2865
Country	:	US
Telephone Number	:	617-462-7283
Fax Number	:

Provider Business Practice Location Address
First Line	:	1032 TURNPIKE ST
Second Line	:	SUITE 204
City	:	CANTON
State	:	MA
Zip	:	02021-2865
Country	:	US
Telephone Number	:	617-462-7283
Fax Number	:

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

Provider Enumeration Date	:	09/15/2009
Last Update Date	:	11/18/2010

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