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Individual
MELISSA R BOURQUE
Active
Individual
MELISSA R BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10219
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008062581
—
CT
01
—
060669107
UBH-CONNECTICARE WELLMORE GRP/FACILITY
CT
01
—
13671798
CAQH
CT
01
—
D339209
VALUE OPTIONS/BEACON HEALTH STRATEGIES
CT
01
—
NOT ELIGIBLE
MHN TRICARE NORTH
CT
01
—
PENDING
AETNA BEHAVIORAL HEALTH
CT
Enumeration date
07/09/2015
Last updated
05/07/2018
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