Provider Demographics
NPI:1548584642
Name:MELENDEZ, TRACEE JOY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TRACEE
Middle Name:JOY
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4348
Mailing Address - Country:US
Mailing Address - Phone:860-227-4334
Mailing Address - Fax:860-632-7973
Practice Address - Street 1:1177 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4348
Practice Address - Country:US
Practice Address - Phone:860-227-4334
Practice Address - Fax:860-632-7973
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0067881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical