Provider Demographics
NPI:1154187045
Name:PLOURDE, MELISSA ARDEN (LSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ARDEN
Last Name:PLOURDE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 BOULDER RD
Mailing Address - Street 2:
Mailing Address - City:BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02630-1629
Mailing Address - Country:US
Mailing Address - Phone:508-414-8694
Mailing Address - Fax:
Practice Address - Street 1:33 ARCH ST FL 17
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1424
Practice Address - Country:US
Practice Address - Phone:857-505-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA313172104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker