Provider Demographics
NPI:1043636582
Name:ST.GERMAIN, MELANIE BETH (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:BETH
Last Name:ST.GERMAIN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:BETH
Other - Last Name:ST. GERMAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:1177 SILAS DEANE HWY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4348
Mailing Address - Country:US
Mailing Address - Phone:860-966-9237
Mailing Address - Fax:
Practice Address - Street 1:1177 SILAS DEANE HWY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4348
Practice Address - Country:US
Practice Address - Phone:860-966-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1747106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist