Healthcare Provider Details

I. General information

NPI: 1457167223
Provider Name (Legal Business Name): MELISSA ANN ZAGAROLI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TRAP FALLS RD STE 405
SHELTON CT
06484-4670
US

IV. Provider business mailing address

104 MAPLE AVE
NORTH HAVEN CT
06473-2606
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-1954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number014051
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: