Provider Demographics
NPI:1548496458
Name:CASTILLO, MELISSA (PHD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:CASTILLO
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 1:777 W PUTNAM AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5000
Mailing Address - Country:US
Mailing Address - Phone:203-649-8200
Mailing Address - Fax:203-649-8211
Practice Address - Street 1:777 W PUTNAM AVE STE 300
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5000
Practice Address - Country:US
Practice Address - Phone:203-649-8200
Practice Address - Fax:203-648-8211
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT003993103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid