Healthcare Provider Details

I. General information

NPI: 1164355988
Provider Name (Legal Business Name): ALYSSA CAIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 LIBERTY RD STE G
RANDALLSTOWN MD
21133-1054
US

IV. Provider business mailing address

11100 LIBERTY RD STE G
RANDALLSTOWN MD
21133-1054
US

V. Phone/Fax

Practice location:
  • Phone: 410-988-4664
  • Fax:
Mailing address:
  • Phone: 410-988-4664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA L. CAIN
Title or Position: OWNER
Credential: NP
Phone: 410-988-4664