MEDICARE: MRS. MELINDA HOPE GIRARDIN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	007548	CT

General Provider Information

NPI Number	:	1124312178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELINDA HOPE GIRARDIN LCSW

Provider Business Mailing Address
First Line	:	214 S LAKE ST
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-3526
Country	:	US
Telephone Number	:	860-459-8674
Fax Number	:	860-361-6294

Provider Business Practice Location Address
First Line	:	214 S LAKE ST
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-3526
Country	:	US
Telephone Number	:	860-459-8674
Fax Number	:	860-361-6294

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2011
Last Update Date	:	04/29/2016

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