Provider Demographics
NPI:1215202437
Name:MITCHELL, MELANIE (MS,BA,LPC)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS,BA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:30 PECK RD
Practice Address - Street 2:BUILDING 2 SUITE#2203
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6123
Practice Address - Country:US
Practice Address - Phone:860-626-7007
Practice Address - Fax:860-626-7014
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2516101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4930230OtherCIGNA BEHAVIORAL HEALTH
CT531888OtherMHN MANAGED HEALTH NETWORK
CT060669107OtherUNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT060669107OtherUBH- CONNECTICARE WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTH WELLMORE GRP/FACILITY
CT12714353OtherCAQH
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CT060669107OtherUBH-LIBERTY/FREEDOM OXFORD WELLMORE GRP/FACILITY
CT531888OtherMHN TRICARE NORTH
CT008050691Medicaid
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CTD339225-PINE STOtherVALUE OPTIONS
CTNOT ELIGIBLEMedicare PIN