Provider Demographics
NPI:1609329218
Name:GARBOSKI, MELISSA ANN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:GARBOSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MAMMOTH RD
Mailing Address - Street 2:APT 2
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2219
Mailing Address - Country:US
Mailing Address - Phone:978-596-6610
Mailing Address - Fax:
Practice Address - Street 1:215 MAMMOTH RD
Practice Address - Street 2:APT 2
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2219
Practice Address - Country:US
Practice Address - Phone:978-596-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health