Healthcare Provider Details

I. General information

NPI: 1528767225
Provider Name (Legal Business Name): ALYSSA LEE CAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA LEE ZUCKERMAN PMHNP

II. Dates (important events)

Enumeration Date: 03/01/2023
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

1904 STONERIDGE CT
MARRIOTTSVILLE MD
21104-1023
US

V. Phone/Fax

Practice location:
  • Phone: 410-988-4664
  • Fax:
Mailing address:
  • Phone: 808-352-8606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR208190
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR208190
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: