Provider Demographics
NPI:1558031948
Name:AVELINE PSYCHIATRY LLC
Entity Type:Organization
Organization Name:AVELINE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:MELVIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:917-856-7195
Mailing Address - Street 1:13 COVENTRY WAY
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1671
Mailing Address - Country:US
Mailing Address - Phone:917-856-7195
Mailing Address - Fax:
Practice Address - Street 1:2553 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3021
Practice Address - Country:US
Practice Address - Phone:917-856-7195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty