Provider Demographics
NPI:1285450379
Name:ROOT, MELISSA M (PHD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:M
Last Name:ROOT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WESTOMERE TER
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4410
Mailing Address - Country:US
Mailing Address - Phone:860-389-8589
Mailing Address - Fax:
Practice Address - Street 1:92 EUGENE ONEILL DR
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6402
Practice Address - Country:US
Practice Address - Phone:860-389-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC062024000280103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling