Provider Demographics
NPI:1023559143
Name:POLANCO, MELISSA H (LMHC, LCDP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:H
Last Name:POLANCO
Suffix:
Gender:F
Credentials:LMHC, LCDP
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:LA
Other - Last Name:HIGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, LCDP
Mailing Address - Street 1:530 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5762
Mailing Address - Country:US
Mailing Address - Phone:401-491-5917
Mailing Address - Fax:401-491-5916
Practice Address - Street 1:530 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5762
Practice Address - Country:US
Practice Address - Phone:401-528-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00916101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health