Provider Demographics
NPI:1649914722
Name:MELANSON, KRYSTLE MARIE (MA)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:MARIE
Last Name:MELANSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MEADOW ST APT 50
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2232
Mailing Address - Country:US
Mailing Address - Phone:413-530-1222
Mailing Address - Fax:
Practice Address - Street 1:103 MYRON ST STE A
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1485
Practice Address - Country:US
Practice Address - Phone:141-353-0122
Practice Address - Fax:413-439-0096
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health