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General NPI Number Information
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NPI Number | 1578046496
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Entity Type | Individual
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Provider Name | MADELYNN VASSALLO MSW,MPH
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Gender | Female
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 273 COUNTY RD
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City | NEW LONDON
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State | NH
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Zip | 03257-5736
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Country | US
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Telephone | 603-526-5425
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Fax |
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Provider Business Mailing Address
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Address Line | 273 COUNTY RD
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City | NEW LONDON
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State | NH
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Zip | 03257-5736
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1022659
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2267
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License Number State | NH
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