Provider Demographics
NPI:1346457439
Name:MELANSON, GAIL (PHD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:MELANSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EAST AVENUE
Mailing Address - Street 2:MID FAIRFIELD CHILD GUIDANCE CENTER
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:203-299-1315
Mailing Address - Fax:
Practice Address - Street 1:100 EAST AVENUE
Practice Address - Street 2:MID FAIRFIELD CHILD GUIDANCE CENTER
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-299-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical