Healthcare Provider Details

I. General information

NPI: 1174468540
Provider Name (Legal Business Name): ALYSSA THERESA DIGIOVANNA RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 PGA BLVD STE 134
PALM BEACH GARDENS FL
33410-3515
US

IV. Provider business mailing address

11419 165TH RD N
JUPITER FL
33478-6148
US

V. Phone/Fax

Practice location:
  • Phone: 561-532-7768
  • Fax:
Mailing address:
  • Phone: 631-682-1867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number29199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: