Provider Demographics
NPI:1609123934
Name:HATHAWAY, MELANIE GAIL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:GAIL
Last Name:HATHAWAY
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 1:100 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1138
Mailing Address - Country:US
Mailing Address - Phone:860-531-9559
Mailing Address - Fax:860-781-6224
Practice Address - Street 1:100 LINWOOD AVE FL 1
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1138
Practice Address - Country:US
Practice Address - Phone:860-531-9559
Practice Address - Fax:860-781-6224
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0080161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical