Provider Demographics
NPI:1477158046
Name:MELLAHEALTH LLC
Entity Type:Organization
Organization Name:MELLAHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IVY
Authorized Official - Middle Name:SARA
Authorized Official - Last Name:PATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-810-0587
Mailing Address - Street 1:125 LASALLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2311
Mailing Address - Country:US
Mailing Address - Phone:860-342-8192
Mailing Address - Fax:860-523-4225
Practice Address - Street 1:125 LASALLE RD STE 300
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2311
Practice Address - Country:US
Practice Address - Phone:860-342-8192
Practice Address - Fax:860-523-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty