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General NPI Number Information
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NPI Number | 1528309978
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Entity Type | Individual
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Provider Name | MELANIE RICHARDSON-SEVERO LAC
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Gender | Female
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Dates
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Enumeration Date | 03/11/2013
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 21 CARMICHAEL ST STE 101
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-3186
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Country | US
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Telephone | 802-662-1066
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Fax | 802-347-2095
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Provider Business Mailing Address
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Address Line | 4 PEARL ST APT 301
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-4097
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Country | US
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Telephone | 718-219-6053
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Fax | 802-347-2095
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 004937-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 091.0134014
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License Number State | VT
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