Provider Demographics
NPI:1215198478
Name:MELLEN, THERESA JEANNE (LMHC CAGS)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:JEANNE
Last Name:MELLEN
Suffix:
Gender:F
Credentials:LMHC CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2025
Mailing Address - Street 2:10 BEDFORD STREET
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351
Mailing Address - Country:US
Mailing Address - Phone:781-871-2015
Mailing Address - Fax:781-871-5558
Practice Address - Street 1:10 BEDFORD STREET
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351
Practice Address - Country:US
Practice Address - Phone:781-871-2015
Practice Address - Fax:781-871-5558
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC3851101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor