Healthcare Provider Details

I. General information

NPI: 1023788155
Provider Name (Legal Business Name): ALYSON REZENDES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 HIGH ST STE DH27
MEDFORD MA
02155-3841
US

IV. Provider business mailing address

92 HIGH ST STE DH27
MEDFORD MA
02155-3841
US

V. Phone/Fax

Practice location:
  • Phone: 617-702-9131
  • Fax: 617-812-2512
Mailing address:
  • Phone: 617-702-9131
  • Fax: 617-812-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10005900
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: