Healthcare Provider Details

I. General information

NPI: 1851395206
Provider Name (Legal Business Name): MARYCELY ALESSI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 LOUISIANA AVE SUITE 106
WINTER PARK FL
32789-2341
US

IV. Provider business mailing address

1155 LOUISIANA AVE SUITE 106
WINTER PARK FL
32789-2341
US

V. Phone/Fax

Practice location:
  • Phone: 407-629-4356
  • Fax: 407-629-1812
Mailing address:
  • Phone: 407-629-4356
  • Fax: 407-629-1812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPSY002569
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY 7566
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: