Provider Demographics
NPI:1215296132
Name:GOSS, MELISSA JANE (MS)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JANE
Last Name:GOSS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:JANE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 W PEARL ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3343
Mailing Address - Country:US
Mailing Address - Phone:603-889-6147
Mailing Address - Fax:603-882-2017
Practice Address - Street 1:5 PINE STREET EXT
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3248
Practice Address - Country:US
Practice Address - Phone:603-889-6147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-12
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18633OtherBCBS
MA99618201OtherNETWORK HEALTH
MA0000023532OtherBMC
MA1004745OtherNHP
MA042611055OtherTAX ID
MA1004745OtherFALLON
MA1303287OtherMBHP