Healthcare Provider Details

I. General information

NPI: 1275478208
Provider Name (Legal Business Name): ALYSSA BLACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 ROSEWOOD DR STE 300
DANVERS MA
01923-1388
US

IV. Provider business mailing address

286 MAIN ST APT 2
AMESBURY MA
01913-3773
US

V. Phone/Fax

Practice location:
  • Phone: 978-494-8163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: