Healthcare Provider Details

I. General information

NPI: 1750969572
Provider Name (Legal Business Name): ALYSSA LOGRASSO POWER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S RIVER RD STE 307
BEDFORD NH
03110-6716
US

IV. Provider business mailing address

25 S RIVER RD STE 307
BEDFORD NH
03110-6716
US

V. Phone/Fax

Practice location:
  • Phone: 781-454-9964
  • Fax:
Mailing address:
  • Phone: 781-454-9964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0136313TELE
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3243
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW127474
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: