Provider Demographics
NPI:1023507720
Name:DELVAGLIO, MELISSA ANNE (MSW, LABA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:DELVAGLIO
Suffix:
Gender:F
Credentials:MSW, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ELISHA DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-3447
Mailing Address - Country:US
Mailing Address - Phone:781-910-3951
Mailing Address - Fax:
Practice Address - Street 1:1831 OCEAN ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-4977
Practice Address - Country:US
Practice Address - Phone:781-789-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA870103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA870OtherLICENSED BEHAVIOR ANALYSIS