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General NPI Number Information
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NPI Number | 1265034862
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Entity Type | Individual
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Provider Name | ALLISSA TAMISO LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 360 MAIN ST STE 2D
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3375
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Country | US
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Telephone | 860-248-6046
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Fax |
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Provider Business Mailing Address
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Address Line | 360 MAIN ST STE 2D
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3375
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 46.005599
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License Number State | CT
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