Provider Demographics
NPI:1760548143
Name:SANSONE, MELISSA J (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:J
Last Name:SANSONE
Suffix:
Gender:F
Credentials:LMHC
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Mailing Address - Street 1:55 LAKE AVE N
Mailing Address - Street 2:UMASS MEMORIAL MEDICAL CENTER, PSYCHIATRY
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655-0002
Mailing Address - Country:US
Mailing Address - Phone:508-334-3562
Mailing Address - Fax:508-421-1000
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:UMASS MEMORIAL MEDICAL CENTER, PSYCHIATRY
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-3562
Practice Address - Fax:508-421-1000
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6270OtherLICENSE