Provider Demographics
NPI:1346969722
Name:COFFIN, MELISSA MCLAIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MCLAIN
Last Name:COFFIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:MCLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:76 ELM ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5423
Mailing Address - Country:US
Mailing Address - Phone:203-900-4904
Mailing Address - Fax:
Practice Address - Street 1:76 ELM ST STE 201
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5423
Practice Address - Country:US
Practice Address - Phone:203-900-4904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003668103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling