=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437376597
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA P. DIVITO M.S., LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 S MAIN ST
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06457-3656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-704-0300
-----------------------------------------------------
Fax | 860-343-9144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 265 TRI MOUNTAIN RD
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06422-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-349-3884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 000084
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 000550
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------