Provider Demographics
NPI:1053966929
Name:GREGG, MELISSA M (MSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:GREGG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TSIENNETO RD UNIT 77
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1573
Mailing Address - Country:US
Mailing Address - Phone:603-490-6542
Mailing Address - Fax:
Practice Address - Street 1:66 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3506
Practice Address - Country:US
Practice Address - Phone:603-270-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH11GGM81281OtherNH DRIVER'S LISENCE