Provider Demographics
NPI:1821532425
Name:DEMELLO, CARISSA MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:MARIE
Last Name:DEMELLO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 JACQUELINE WAY
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-2783
Mailing Address - Country:US
Mailing Address - Phone:401-472-4889
Mailing Address - Fax:
Practice Address - Street 1:575 E MAIN RD UNIT 2
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5288
Practice Address - Country:US
Practice Address - Phone:401-271-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW018611041C0700X
MA2211691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical