Healthcare Provider Details

I. General information

NPI: 1922925783
Provider Name (Legal Business Name): ALYSSA EHRENFRIED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 COMMONWEALTH AVE
BOSTON MA
02215-1394
US

IV. Provider business mailing address

35 GARDNER ST APT 16
ALLSTON MA
02134-2142
US

V. Phone/Fax

Practice location:
  • Phone: 617-352-4702
  • Fax:
Mailing address:
  • Phone: 978-799-7486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATL22989
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: