Provider Demographics
NPI:1346122082
Name:TEJADA, MELISSA ANAIS I (MSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANAIS
Last Name:TEJADA
Suffix:I
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANAIS
Other - Last Name:TEJADA
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:11 HERBERT ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-1413
Mailing Address - Country:US
Mailing Address - Phone:781-526-7823
Mailing Address - Fax:
Practice Address - Street 1:66 CANAL ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2002
Practice Address - Country:US
Practice Address - Phone:617-371-3175
Practice Address - Fax:617-371-3038
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)