Healthcare Provider Details

I. General information

NPI: 1457548026
Provider Name (Legal Business Name): MELISSA SANTOS PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR STREET HARTFORD HOSPITAL CHILD PSYCHIATRY
HARTFORD CT
06106-3310
US

IV. Provider business mailing address

PO BOX 40,000 DEPT 634 HARTFORD HOSPITAL PROFESSIONAL SERVICES
HARTFORD CT
06151-0634
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-8660
  • Fax:
Mailing address:
  • Phone: 860-545-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002799
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: