MEDICARE: ALYSSA Y GUSMEROTTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW019820	PA
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1366824831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA Y GUSMEROTTI

Provider Business Mailing Address
First Line	:	131 MARKET ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15901-1628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	598 GALLERIA DR
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-8900
Country	:	US
Telephone Number	:	814-943-8164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	03/23/2022

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Directions to “ ALYSSA Y GUSMEROTTI ” Practice Location

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