Provider Demographics
NPI:1275807547
Name:SMITH, MELANIE MARIE
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MARIE
Last Name:SMITH
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 1:310 BRITTANY FARMS RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1147
Mailing Address - Country:US
Mailing Address - Phone:860-916-3163
Mailing Address - Fax:
Practice Address - Street 1:250 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2910
Practice Address - Country:US
Practice Address - Phone:860-418-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker