Provider Demographics
NPI:1528392198
Name:JONES, MELISSA I
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:JONES
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HILLCREST AVE APT D
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2272
Mailing Address - Country:US
Mailing Address - Phone:860-263-7029
Mailing Address - Fax:
Practice Address - Street 1:111 HILLCREST AVE APT D
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2272
Practice Address - Country:US
Practice Address - Phone:860-263-7029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT137073477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health