Basic Information
| Provider Information | |||||||||
| NPI: | 1578791182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEAN-CHARLES | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ANTOINETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W CUMMINGS PARK | ||||||||
| Address2: | STE 3900 | ||||||||
| City: | WOBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018016503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819328114 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 W CUMMINGS PARK | ||||||||
| Address2: | STE 3900 | ||||||||
| City: | WOBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018016503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819328114 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2009 | ||||||||
| LastUpdateDate: | 08/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 215674 | MA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 116459 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.