Provider Demographics
NPI:1184099889
Name:JOSEPH, MELANIE CATHERINE (LCSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:CATHERINE
Last Name:JOSEPH
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 1:226 DIXWELL AVENUE
Mailing Address - Street 2:NORTHSIDE
Mailing Address - City:HEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3456
Mailing Address - Country:US
Mailing Address - Phone:203-503-3470
Mailing Address - Fax:203-503-3478
Practice Address - Street 1:226 DIXWELL AVENUE
Practice Address - Street 2:NORTHSIDE COMMUNITY OUTPT. SER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3456
Practice Address - Country:US
Practice Address - Phone:203-503-3470
Practice Address - Fax:203-503-3478
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT100671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008078041Medicaid