Provider Demographics
NPI:1033328141
Name:WHITEHOUSE, MELISSA C (MSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:C
Last Name:WHITEHOUSE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 FORTUNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1741
Mailing Address - Country:US
Mailing Address - Phone:508-473-7400
Mailing Address - Fax:508-473-6644
Practice Address - Street 1:409 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1741
Practice Address - Country:US
Practice Address - Phone:508-473-7400
Practice Address - Fax:508-473-6644
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10226601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical