Healthcare Provider Details

I. General information

NPI: 1366824831
Provider Name (Legal Business Name): ALYSSA Y GUSMEROTTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 GALLERIA DR
JOHNSTOWN PA
15904-8900
US

IV. Provider business mailing address

131 MARKET ST
JOHNSTOWN PA
15901-1628
US

V. Phone/Fax

Practice location:
  • Phone: 814-943-8164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW019820
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: