Provider Demographics
NPI:1174083455
Name:MANOCK, MELYSSA LEE (MLADC)
Entity type:Individual
Prefix:
First Name:MELYSSA
Middle Name:LEE
Last Name:MANOCK
Suffix:
Gender:F
Credentials:MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 INDUSTRIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235-2507
Mailing Address - Country:US
Mailing Address - Phone:603-671-7045
Mailing Address - Fax:603-556-8546
Practice Address - Street 1:67 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-2507
Practice Address - Country:US
Practice Address - Phone:603-671-7045
Practice Address - Fax:603-556-8456
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NH1206101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1598302523Medicaid