Healthcare Provider Details

I. General information

NPI: 1629227343
Provider Name (Legal Business Name): MELISSA MARIE BICKFORD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 ROLLING GREEN RD
BETHANY CT
06524-3321
US

IV. Provider business mailing address

41 ROLLING GREEN RD
BETHANY CT
06524-3321
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001228
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: