Provider Demographics
NPI:1568284461
Name:VIDEIRA, MELISSA MARIE (MS, SYC, LPCA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:VIDEIRA
Suffix:
Gender:F
Credentials:MS, SYC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 SOUNDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-2181
Mailing Address - Country:US
Mailing Address - Phone:203-258-7175
Mailing Address - Fax:
Practice Address - Street 1:1 ENTERPRISE DR STE 415
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4631
Practice Address - Country:US
Practice Address - Phone:203-255-5078
Practice Address - Fax:203-295-7663
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional