Provider Demographics
NPI:1760762538
Name:HODGSON, MELISSA ANN (PSYD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:HODGSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:210 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-2330
Mailing Address - Country:US
Mailing Address - Phone:860-474-3764
Mailing Address - Fax:
Practice Address - Street 1:210 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06073-2330
Practice Address - Country:US
Practice Address - Phone:860-474-3764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003367103TC0700X
CT3367103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical