Provider Demographics
NPI:1548534316
Name:YAZDANPANAH, MELISSA ELEANOR (LICSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ELEANOR
Last Name:YAZDANPANAH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BALL HILL RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MA
Mailing Address - Zip Code:01541-2107
Mailing Address - Country:US
Mailing Address - Phone:978-464-2610
Mailing Address - Fax:
Practice Address - Street 1:123 BALL HILL RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MA
Practice Address - Zip Code:01541-2107
Practice Address - Country:US
Practice Address - Phone:978-464-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10269951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical