Provider Demographics
NPI:1972255081
Name:MELIUS, JACQUELINE (LICSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MELIUS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2743
Mailing Address - Country:US
Mailing Address - Phone:339-226-0432
Mailing Address - Fax:415-481-4318
Practice Address - Street 1:352 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2743
Practice Address - Country:US
Practice Address - Phone:339-226-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1280191041C0700X
MA227284104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker