Healthcare Provider Details

I. General information

NPI: 1932563269
Provider Name (Legal Business Name): MELISSA MIELE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 TOWN ST
NORWICH CT
06360-2323
US

IV. Provider business mailing address

91 NORTHWEST DR
PLAINVILLE CT
06062-1534
US

V. Phone/Fax

Practice location:
  • Phone: 860-892-7042
  • Fax:
Mailing address:
  • Phone: 888-793-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10812
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: