Healthcare Provider Details

I. General information

NPI: 1811627540
Provider Name (Legal Business Name): ALYSSA JOHNSTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA RUTKOWSKI LCSW

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 SILAS DEANE HWY
WETHERSFIELD CT
06109-1265
US

IV. Provider business mailing address

86 COOK HILL RD
WINDSOR CT
06095-3153
US

V. Phone/Fax

Practice location:
  • Phone: 508-612-2228
  • Fax:
Mailing address:
  • Phone: 508-612-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6548
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: