Provider Demographics
NPI:1871997379
Name:MORAN, MELBOURNE RICHARD JR (MSW)
Entity type:Individual
Prefix:
First Name:MELBOURNE
Middle Name:RICHARD
Last Name:MORAN
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 AMHERST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-4223
Mailing Address - Country:US
Mailing Address - Phone:603-889-3553
Mailing Address - Fax:603-589-4981
Practice Address - Street 1:400 AMHERST ST STE 200
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-4223
Practice Address - Country:US
Practice Address - Phone:603-889-3553
Practice Address - Fax:603-589-4981
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA613129591041C0700X
MA1203811041C0700X
NH20941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical