Provider Demographics
NPI:1629235668
Name:DEMARE, MELANIE E (LMFT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:E
Last Name:DEMARE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1327
Mailing Address - Country:US
Mailing Address - Phone:203-437-0489
Mailing Address - Fax:
Practice Address - Street 1:576 RUBBER AVE
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-3751
Practice Address - Country:US
Practice Address - Phone:203-437-0489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001073106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist