Provider Demographics
NPI:1487145207
Name:MELNYCK, KELLY TAYLOR (MA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:TAYLOR
Last Name:MELNYCK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ATWATER ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1776
Mailing Address - Country:US
Mailing Address - Phone:413-250-1285
Mailing Address - Fax:
Practice Address - Street 1:130 MAPLE ST STE 325
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2215
Practice Address - Country:US
Practice Address - Phone:413-737-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health