Provider Demographics
NPI:1861893612
Name:PERSAUD, MELISSA D (PSYD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 STEEPLECHASE DR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-5703
Mailing Address - Country:US
Mailing Address - Phone:914-954-8456
Mailing Address - Fax:860-432-4679
Practice Address - Street 1:2446 ALBANY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2598
Practice Address - Country:US
Practice Address - Phone:914-954-8456
Practice Address - Fax:860-432-4679
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002774103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling