Provider Demographics
NPI:1932338951
Name:PERKINS-BANAS, MELISSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:PERKINS-BANAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 W EXCHANGE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1000
Mailing Address - Country:US
Mailing Address - Phone:401-351-7779
Mailing Address - Fax:401-351-8188
Practice Address - Street 1:260 W EXCHANGE ST STE 210
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1000
Practice Address - Country:US
Practice Address - Phone:401-351-7779
Practice Address - Fax:401-351-8188
Is Sole Proprietor?:No
Enumeration Date:2009-07-12
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002942103G00000X
RIPS01157103G00000X
CT2941103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist