Provider Demographics
NPI:1679648976
Name:HYMAN, MELVYN (PHD)
Entity Type:Individual
Prefix:
First Name:MELVYN
Middle Name:
Last Name:HYMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-874-3749
Mailing Address - Fax:203-874-3749
Practice Address - Street 1:266 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-874-3749
Practice Address - Fax:203-874-3749
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001472103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001472CT01OtherANTHEM
CT004114617Medicaid
CT107928OtherVALUE OPTIONS
CT004114617Medicaid