Healthcare Provider Details

I. General information

NPI: 1285551143
Provider Name (Legal Business Name): ALYSSA PENNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 DREW ST STE 101
CLEARWATER FL
33765-2921
US

IV. Provider business mailing address

4777 122ND AVE N
CLEARWATER FL
33762-4420
US

V. Phone/Fax

Practice location:
  • Phone: 727-303-2523
  • Fax:
Mailing address:
  • Phone: 727-773-7894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: