Provider Demographics
NPI:1770891913
Name:RICHARDSON, MELISSA (LMHC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:RAPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1 CUMBERLAND ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3327
Mailing Address - Country:US
Mailing Address - Phone:401-309-3642
Mailing Address - Fax:401-769-6046
Practice Address - Street 1:80 FABIEN ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-6277
Practice Address - Country:US
Practice Address - Phone:401-309-3642
Practice Address - Fax:401-769-6046
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5190Medicaid