Provider Demographics
NPI:1639884851
Name:REDMOND, MELISSA (LPCA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:REDMOND
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 RIDGE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6318
Mailing Address - Country:US
Mailing Address - Phone:203-253-2563
Mailing Address - Fax:
Practice Address - Street 1:24 RIDGE ST APT 2
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6318
Practice Address - Country:US
Practice Address - Phone:203-253-2563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CT5838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health