Provider Demographics
NPI:1316436207
Name:BLAND, MELONIE K
Entity type:Individual
Prefix:
First Name:MELONIE
Middle Name:K
Last Name:BLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-4052
Mailing Address - Country:US
Mailing Address - Phone:203-218-8883
Mailing Address - Fax:
Practice Address - Street 1:25 ROBERT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-4052
Practice Address - Country:US
Practice Address - Phone:203-218-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional