Provider Demographics
NPI:1720486558
Name:OLCZAK, MELISSA RACHEL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RACHEL
Last Name:OLCZAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 CANDLEWYCK DR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-5229
Mailing Address - Country:US
Mailing Address - Phone:860-808-7456
Mailing Address - Fax:
Practice Address - Street 1:35 COLD SPRING RD STE 514
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3165
Practice Address - Country:US
Practice Address - Phone:860-808-7456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002666101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004140505Medicaid