Provider Demographics
NPI:1912232752
Name:MEEHAN, MELISSA A (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:MEEHAN
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:PO BOX 2492
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-0492
Mailing Address - Country:US
Mailing Address - Phone:203-321-9293
Mailing Address - Fax:203-595-9280
Practice Address - Street 1:666 GLENBROOK RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906-1439
Practice Address - Country:US
Practice Address - Phone:203-321-9293
Practice Address - Fax:203-595-9280
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional