Provider Demographics
NPI:1184604381
Name:LEVEILLE, MICHELLE NITTO (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:NITTO
Last Name:LEVEILLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:NITTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:97 WHITTLESEY RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-2535
Mailing Address - Country:US
Mailing Address - Phone:203-510-1494
Mailing Address - Fax:203-573-7007
Practice Address - Street 1:750 OLD MAIN ST
Practice Address - Street 2:SUITE 306
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1567
Practice Address - Country:US
Practice Address - Phone:860-524-7538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical