Healthcare Provider Details

I. General information

NPI: 1437098050
Provider Name (Legal Business Name): ALYSSA GIBSON I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S EAST ST
AMHERST MA
01002-2406
US

IV. Provider business mailing address

3 GREAT BROOK VALLEY AVE APT 3
WORCESTER MA
01605-3556
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-1954
  • Fax:
Mailing address:
  • Phone: 617-855-1954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: