Provider Demographics
NPI:1669606174
Name:MEL A. SOLIS INC.
Entity type:Organization
Organization Name:MEL A. SOLIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-642-4968
Mailing Address - Street 1:166 EAST AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5731
Mailing Address - Country:US
Mailing Address - Phone:203-642-4968
Mailing Address - Fax:203-846-0799
Practice Address - Street 1:166 EAST AVE STE 101
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5731
Practice Address - Country:US
Practice Address - Phone:203-642-4968
Practice Address - Fax:203-846-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0022381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800002313Medicare PIN