=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801501218
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALYSE GILBERT, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2023
-----------------------------------------------------
Last Update Date | 03/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13753 NW 22ND PL
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33323-5310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-224-8784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13753 NW 22ND PL
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33323-5310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-224-8784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALYSE MICHELLE GILBERT
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 954-224-8784
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------