Provider Demographics
NPI:1528309978
Name:RICHARDSON-SEVERO, MELANIE (LAC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:RICHARDSON-SEVERO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PEARL ST APT 301
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-4097
Mailing Address - Country:US
Mailing Address - Phone:718-219-6053
Mailing Address - Fax:802-347-2095
Practice Address - Street 1:21 CARMICHAEL ST STE 101
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3186
Practice Address - Country:US
Practice Address - Phone:802-662-1066
Practice Address - Fax:802-347-2095
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004937-1171100000X
VT091.0134014171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist