Provider Demographics
NPI:1174099394
Name:BOISVERT, MELISSA (LMHC, LCMHC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BOISVERT
Suffix:
Gender:F
Credentials:LMHC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4138
Mailing Address - Country:US
Mailing Address - Phone:774-364-1472
Mailing Address - Fax:
Practice Address - Street 1:370 MERRIMACK ST STE 240
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1789
Practice Address - Country:US
Practice Address - Phone:603-960-0389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health