Healthcare Provider Details

I. General information

NPI: 1528979945
Provider Name (Legal Business Name): ALYSSA LINDENBAUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 1ST AVE STE 2
KING OF PRUSSIA PA
19406-4033
US

IV. Provider business mailing address

29 HULSE LANDING RD
BRICK NJ
08723-5715
US

V. Phone/Fax

Practice location:
  • Phone: 610-595-5517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC017916
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01285500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: