Provider Demographics
NPI:1225118797
Name:GATICA, MELISSA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:S
Last Name:GATICA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:LEONARD
Other - Last Name:GATICA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:682 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4238
Mailing Address - Country:US
Mailing Address - Phone:860-233-2575
Mailing Address - Fax:860-523-1366
Practice Address - Street 1:682 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4238
Practice Address - Country:US
Practice Address - Phone:860-233-2575
Practice Address - Fax:860-523-1366
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical