Basic Information
| Provider Information | |||||||||
| NPI: | 1609198670 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALDER | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 763 BURNSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | EAST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061082791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602919787 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 445 CYPRESS ST | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031033600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036684079 | ||||||||
| FaxNumber: | 6036638605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2010 | ||||||||
| LastUpdateDate: | 09/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1442 | NH | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 8427 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | RE6661 | 01 | NH | MEDICARE GROUP PTAN | OTHER |