Healthcare Provider Details

I. General information

NPI: 1295184638
Provider Name (Legal Business Name): MISS ALYSSA ROSE CUMPSTONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 BSULLAK RD
BARKHAMSTED CT
06063-3306
US

IV. Provider business mailing address

187 S CANAAN RD
CANAAN CT
06018-2544
US

V. Phone/Fax

Practice location:
  • Phone: 860-212-5961
  • Fax:
Mailing address:
  • Phone: 860-824-1397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number004331
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: