Provider Demographics
NPI:1437804101
Name:SHUTE, MELISSA ANN (MS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:SHUTE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BARNARD LN STE 304
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2495
Mailing Address - Country:US
Mailing Address - Phone:860-797-5306
Mailing Address - Fax:860-310-3292
Practice Address - Street 1:3 BARNARD LN STE 304
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2495
Practice Address - Country:US
Practice Address - Phone:860-797-5306
Practice Address - Fax:860-310-3292
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional