Individual provider Active NPI

Melinda Silva Grant, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Woodbridge, CT
National Provider Identifier
1407106446
Registry record updated Jan 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
12432 Issued in CT
Practice address
1 Bradley Rd
Woodbridge, CT 06525-2285
Phone
(203) 463-4555
NPI assigned
Sep 18, 2012
Last updated
Jan 13, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 12432 CT Primary
Clinical Social Worker 1041C0700X 007898 CT

Addresses

Primary practice location

1 Bradley Rd
Woodbridge, CT 06525-2285

Mailing address

1 Bradley Rd
Woodbridge, CT 06525-2285
Phone (203) 463-4555

Other identifiers 1

IdentifierTypeStateIssuer
004235918MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121009000026 CT Practitioner - Clinical Social Worker 5698924611 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
007898CTMDClinical Social Worker
12432CTMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
State of Connecticut CurrentSince Oct 3, 2018 Accepting new patients
Lifespan Collaborative Services LLC Psychiatric/Mental Health Past Accepting new patients

Locations

165 Capitol Ave
Ste 2000
Hartford, CT 06106

34 Park St
North Haven, CT 06519
Phone (203) 974-7417

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705104000000",
    "number": "1407106446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BRADLEY RD",
            "city": "WOODBRIDGE",
            "state": "CT",
            "postal_code": "065252285",
            "telephone_number": "203-463-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BRADLEY RD",
            "city": "WOODBRIDGE",
            "state": "CT",
            "postal_code": "065252285",
            "telephone_number": "203-463-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SILVA GRANT",
        "first_name": "MELINDA",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-18",
        "last_updated": "2024-01-13",
        "certification_date": "2024-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "12432",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "007898",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004235918",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, CT

Sources for this page

Verify at the official NPI Registry.