Healthcare Provider Details

I. General information

NPI: 1063238319
Provider Name (Legal Business Name): ALYSSA JOY CAGGIANO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 2ND AVE UNIT F
CONWAY SC
29526-5215
US

IV. Provider business mailing address

4589 DAY LILY RUN ST
MYRTLE BEACH SC
29579-4679
US

V. Phone/Fax

Practice location:
  • Phone: 843-902-1522
  • Fax:
Mailing address:
  • Phone: 732-948-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17443
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: