Provider Demographics
NPI:1982188496
Name:ASSELIN, MEG MARIE
Entity Type:Individual
Prefix:
First Name:MEG
Middle Name:MARIE
Last Name:ASSELIN
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 1:1695 MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1348
Mailing Address - Country:US
Mailing Address - Phone:413-739-5572
Mailing Address - Fax:413-739-9972
Practice Address - Street 1:1695 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1348
Practice Address - Country:US
Practice Address - Phone:413-739-5572
Practice Address - Fax:413-739-9972
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
MA10000886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health