Provider Demographics
NPI:1346949682
Name:VASSALLO, ASHLEY PICKNELLY (LMSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:PICKNELLY
Last Name:VASSALLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LISE CIR
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-1381
Mailing Address - Country:US
Mailing Address - Phone:413-530-7038
Mailing Address - Fax:
Practice Address - Street 1:880 BURBANK AVE
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-1459
Practice Address - Country:US
Practice Address - Phone:413-530-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health