Provider Demographics
NPI:1033405998
Name:MELLO-KENNEDY, CARYN
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:MELLO-KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HILL TOP VW
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1516
Mailing Address - Country:US
Mailing Address - Phone:860-669-5896
Mailing Address - Fax:
Practice Address - Street 1:8 HILL TOP VW
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-1516
Practice Address - Country:US
Practice Address - Phone:860-669-5896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst