Provider Demographics
NPI:1124312178
Name:GIRARDIN, MELINDA HOPE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:HOPE
Last Name:GIRARDIN
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 1:214 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-3526
Mailing Address - Country:US
Mailing Address - Phone:860-459-8674
Mailing Address - Fax:860-361-6294
Practice Address - Street 1:214 S LAKE ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3526
Practice Address - Country:US
Practice Address - Phone:860-459-8674
Practice Address - Fax:860-361-6294
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0075481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical