Provider Demographics
NPI:1609062470
Name:ALSUP, MELISSA RAE
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RAE
Last Name:ALSUP
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 1:331 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-5836
Mailing Address - Country:US
Mailing Address - Phone:860-889-8346
Mailing Address - Fax:860-889-2658
Practice Address - Street 1:331 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5836
Practice Address - Country:US
Practice Address - Phone:860-889-8346
Practice Address - Fax:860-889-2658
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical