Provider Demographics
NPI:1528672565
Name:MELENDEZ, SAMSON MICHAEL
Entity type:Individual
Prefix:MR
First Name:SAMSON
Middle Name:MICHAEL
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 KING ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2336
Mailing Address - Country:US
Mailing Address - Phone:413-317-4095
Mailing Address - Fax:
Practice Address - Street 1:1 ARCH PL
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2457
Practice Address - Country:US
Practice Address - Phone:413-774-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1134107113Medicaid