MEDICARE: ALYSSA DONATO RBT

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	106S00000X	Behavior Technician	20-132112	NC
2	103K00000X	Behavior Analyst	1-23-64971	NC

General Provider Information

NPI Number	:	1376290767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA DONATO RBT

Provider Business Mailing Address
First Line	:	3851 DUNHAGAN RD STE 102
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-6640
Country	:	US
Telephone Number	:	252-751-0518
Fax Number	:

Provider Business Practice Location Address
First Line	:	3171 WRIGHTSVILLE AVE
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-4184
Country	:	US
Telephone Number	:	252-751-0518
Fax Number	:

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

Provider Enumeration Date	:	03/04/2022
Last Update Date	:	04/17/2023

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