Clinician Application Clinician Application Form Please enable JavaScript in your browser to complete this form.1Profile2Additional Details3Additional DetailsNameEmail *PhoneNextAre you a licensed mental health provider by the state of Connecticut?YesNoType of license held:Licensed clinical social worker (LCSW)Licensed professional counselor (LPC)Licensed marriage and family counselor (LMFT)Licensed clinical psychologist (PhD/PsyD)Other (please specify)On average, how many hours per week, are you interest in working for MellaHealth?0-10 hours per week10-20 hours per week20-30 hours per week30-40 hours per week40+ hours per weekPreviousNextIs there any additional information you would like to share with us?Please upload your resume herePreviousSubmit
