Healthcare Provider Details

I. General information

NPI: 1881063550
Provider Name (Legal Business Name): MELINA SOFIA CALLE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WINTHROP ST
NEW BRITAIN CT
06052-1728
US

IV. Provider business mailing address

58 PRENDIVILLE WAY
MARLBOROUGH MA
01752-1740
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-8192
  • Fax:
Mailing address:
  • Phone: 860-287-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: