Healthcare Provider Details

I. General information

NPI: 1932338951
Provider Name (Legal Business Name): MELISSA PERKINS-BANAS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2009
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 W EXCHANGE ST STE 210
PROVIDENCE RI
02903-1000
US

IV. Provider business mailing address

260 W EXCHANGE ST STE 210
PROVIDENCE RI
02903-1000
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-7779
  • Fax: 401-351-8188
Mailing address:
  • Phone: 401-351-7779
  • Fax: 401-351-8188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number002942
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS01157
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2941
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: