MEDICARE: ALYSSA MARIE RAELYNN LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	105447	TX

General Provider Information

NPI Number	:	1063302404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MARIE RAELYNN LMSW

Provider Business Mailing Address
First Line	:	7929 CHURCHILL WAY APT 1122
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-2080
Country	:	US
Telephone Number	:	469-947-4885
Fax Number	:	469-947-4885

Provider Business Practice Location Address
First Line	:	5455 LA SIERRA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4178
Country	:	US
Telephone Number	:	214-691-1001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	07/07/2025

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