Provider Demographics
NPI:1952673865
Name:ALLESANDRINE, CHARLAINE MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:CHARLAINE
Middle Name:MARIE
Last Name:ALLESANDRINE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CHARLAINE
Other - Middle Name:MARIE
Other - Last Name:ST. CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 WEST STREET
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6528
Mailing Address - Country:US
Mailing Address - Phone:203-748-5689
Mailing Address - Fax:203-755-9975
Practice Address - Street 1:30 HOLMES AVENUE
Practice Address - Street 2:
Practice Address - City:WATESBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-2419
Practice Address - Country:US
Practice Address - Phone:203-755-2868
Practice Address - Fax:203-755-9975
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CT6511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional