Provider Demographics
NPI:1063605046
Name:TOWN OF MADISON
Entity type:Organization
Organization Name:TOWN OF MADISON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MELILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-245-5645
Mailing Address - Street 1:10 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3033
Mailing Address - Country:US
Mailing Address - Phone:203-245-5645
Mailing Address - Fax:
Practice Address - Street 1:10 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3033
Practice Address - Country:US
Practice Address - Phone:203-245-5645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health