Provider Demographics
NPI:1295184638
Name:CUMPSTONE, ALYSSA ROSE
Entity Type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:ROSE
Last Name:CUMPSTONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 S CANAAN RD
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018-2544
Mailing Address - Country:US
Mailing Address - Phone:860-824-1397
Mailing Address - Fax:
Practice Address - Street 1:86 BSULLAK RD
Practice Address - Street 2:
Practice Address - City:BARKHAMSTED
Practice Address - State:CT
Practice Address - Zip Code:06063-3306
Practice Address - Country:US
Practice Address - Phone:860-212-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004331101Y00000X
2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant