Provider Demographics
NPI:1275671331
Name:AYANTOTA, MELISSA JANE (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JANE
Last Name:AYANTOTA
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562
Mailing Address - Country:US
Mailing Address - Phone:508-342-5029
Mailing Address - Fax:855-485-5375
Practice Address - Street 1:185 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562
Practice Address - Country:US
Practice Address - Phone:508-342-5029
Practice Address - Fax:855-485-5375
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health