Healthcare Provider Details

I. General information

NPI: 1396487674
Provider Name (Legal Business Name): MELISSA GOBIN, LICSW, LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 GAUMOND RD
NORTH GROSVENORDALE CT
06255-2009
US

IV. Provider business mailing address

64 GAUMOND RD
NORTH GROSVENORDALE CT
06255-2009
US

V. Phone/Fax

Practice location:
  • Phone: 860-377-8995
  • Fax:
Mailing address:
  • Phone: 860-377-8995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MELISSA GOBIN - BORSKI
Title or Position: OWNER
Credential: LICSW, LCSW
Phone: 860-377-8995