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General NPI Number Information
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NPI Number | 1164169538
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Entity Type | Organization
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Legal Business Name | ALYSSA CARL PC
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Dates
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Enumeration Date | 05/17/2022
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 225 N NOTRE DAME AVE STE 5
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City | SOUTH BEND
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State | IN
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Zip | 46617-2836
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Country | US
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Telephone | 517-410-6093
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Fax |
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Provider Business Mailing Address
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Address Line | 55934 TETON CIR
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City | MIDDLEBURY
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State | IN
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Zip | 46540-8795
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Country | US
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Telephone | 517-410-6093
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Fax | 888-676-9051
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Authorized Official
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Title or Position | OWNER
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Name | ALYSSA H CARL
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Credential | LCSW
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Telephone | 517-410-6093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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