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General NPI Number Information
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NPI Number | 1235579418
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Entity Type | Individual
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Provider Name | ALYSSE MELVILLE L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 07/02/2013
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 361 PARK RD 2ND FLOOR
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1911
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Country | US
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Telephone | 860-327-0127
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Fax |
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Provider Business Mailing Address
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Address Line | 10 CONCORD ST APT B4
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1374
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Country | US
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Telephone | 203-313-9498
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 009181
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License Number State | CT
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