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General NPI Number Information
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NPI Number | 1932338951
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Entity Type | Individual
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Provider Name | MELISSA PERKINS-BANAS PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 07/12/2009
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 260 W EXCHANGE ST STE 210
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City | PROVIDENCE
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State | RI
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Zip | 02903-1000
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Country | US
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Telephone | 401-351-7779
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Fax | 401-351-8188
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Provider Business Mailing Address
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Address Line | 260 W EXCHANGE ST STE 210
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City | PROVIDENCE
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State | RI
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Zip | 02903-1000
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Country | US
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Telephone | 401-351-7779
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Fax | 401-351-8188
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 002942
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PS01157
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2941
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License Number State | CT
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