=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639778574
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAIME D'ALESSIO MA, NCC, MFT INTERN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2020
-----------------------------------------------------
Last Update Date | 05/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 413 E PALMETTO PARK RD APT 953
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432-5195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-312-4530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 413 E PALMETTO PARK RD APT 953
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432-5195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-841-3500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | R5969
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------