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NPI Code Detail

MEDICARE: ALYSSA MARIE LIPPUCCI

MEDICARE: ALYSSA MARIE LIPPUCCI
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1710597349
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA MARIE LIPPUCCI
Provider Business Mailing Address
First Line : 3425 COFFEE RD STE C2
Second Line :
City : MODESTO
State : CA
Zip : 95355-1582
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2201 MOUNT ZION PKWY
Second Line :
City : MORROW
State : GA
Zip : 30260-3312
Country : US
Telephone Number : 216-246-7815
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2020
Last Update Date : 04/13/2023

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Directions to “ ALYSSA MARIE LIPPUCCI ” Practice Location

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