Provider Demographics
NPI:1023154689
Name:MICHELLE M NITTO, PSY.D. LLC
Entity type:Organization
Organization Name:MICHELLE M NITTO, PSY.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:NITTO
Authorized Official - Last Name:LEVEILLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:860-524-7538
Mailing Address - Street 1:97 WHITTLESEY RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-2535
Mailing Address - Country:US
Mailing Address - Phone:203-510-1494
Mailing Address - Fax:
Practice Address - Street 1:750 OLD MAIN ST
Practice Address - Street 2:SUITE 306
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1567
Practice Address - Country:US
Practice Address - Phone:860-524-7538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03463Medicare ID - Type UnspecifiedGROUP NUMBER