Provider Demographics
NPI:1508090507
Name:MELILLO, ELAINE C (LPC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:C
Last Name:MELILLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:FAMILY ADVOCACY PROGRAM
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-3410
Mailing Address - Fax:860-358-3404
Practice Address - Street 1:51 BROAD ST
Practice Address - Street 2:FAMILY ADVOCACY PROGRAM
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3204
Practice Address - Country:US
Practice Address - Phone:860-358-3410
Practice Address - Fax:860-358-3404
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001324OtherCT LICENSE