Healthcare Provider Details

I. General information

NPI: 1255889135
Provider Name (Legal Business Name): ALYSSA CHASE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 UNIVERSE CIR
OXNARD CA
93033-2441
US

IV. Provider business mailing address

1690 UNIVERSE CIR
OXNARD CA
93033-2441
US

V. Phone/Fax

Practice location:
  • Phone: 213-407-8209
  • Fax:
Mailing address:
  • Phone: 805-795-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW82171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: