Provider Demographics
NPI:1528499738
Name:MANSOUR, MELINA (LMFT)
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 S MAIN ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1690
Mailing Address - Country:US
Mailing Address - Phone:860-329-7818
Mailing Address - Fax:860-628-3966
Practice Address - Street 1:51 N MAIN ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2537
Practice Address - Country:US
Practice Address - Phone:860-329-7818
Practice Address - Fax:860-628-3966
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000462106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist