Provider Demographics
NPI:1255606661
Name:FLORES, MILISSA (MS,HS-BCP, CAC,LADC)
Entity type:Individual
Prefix:MRS
First Name:MILISSA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:MS,HS-BCP, CAC,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 WHALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3019
Mailing Address - Country:US
Mailing Address - Phone:203-285-6475
Mailing Address - Fax:
Practice Address - Street 1:419 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3019
Practice Address - Country:US
Practice Address - Phone:203-285-6475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CT001064101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor