Healthcare Provider Details

I. General information

NPI: 1316879703
Provider Name (Legal Business Name): KARISSA FALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PARK AVE STE 9
WEST SPRINGFIELD MA
01089-3366
US

IV. Provider business mailing address

337 GOOSEBERRY RD
WEST SPRINGFIELD MA
01089-1950
US

V. Phone/Fax

Practice location:
  • Phone: 413-206-6015
  • Fax:
Mailing address:
  • Phone: 203-623-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10004768
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: