Provider Demographics
NPI:1104671361
Name:GATELY, MELODY RENEE (LSWA)
Entity type:Individual
Prefix:MISS
First Name:MELODY
Middle Name:RENEE
Last Name:GATELY
Suffix:
Gender:F
Credentials:LSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 MAIN ST STE 6B
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2985
Mailing Address - Country:US
Mailing Address - Phone:508-794-5188
Mailing Address - Fax:
Practice Address - Street 1:59 CREIGHTON ST APT 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-1384
Practice Address - Country:US
Practice Address - Phone:781-884-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALSWA416996104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker