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1174888911
RAQUEL MELYSSA PROVDA
LYNN, MA
NPI
1174888911
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: MA LICSW1120818)
Enumeration Date
2012-07-09
Last Update Date
2024-12-04
Business Address
RAQUEL MELYSSA PROVDA LICSW
11 CIRCLE AVE
LYNN, MA 01905-3050
Phone number: 781-595-2413
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Mailing Address
RAQUEL MELYSSA PROVDA LICSW
11 CIRCLE AVE
LYNN, MA 01905-3050
Phone number: 781-595-2413
Copy
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