Healthcare Provider Details

I. General information

NPI: 1497226732
Provider Name (Legal Business Name): ALYSSA FAELLA-AVERSA MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ELLIOTT AVE W STE 500
SEATTLE WA
98119-4292
US

IV. Provider business mailing address

3750 SW 100TH ST
SEATTLE WA
98146-3633
US

V. Phone/Fax

Practice location:
  • Phone: 206-708-6432
  • Fax:
Mailing address:
  • Phone: 206-573-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.61166866
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: