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NPI Code Detail

MEDICARE: ALYSSA ANTHONY

MEDICARE: ALYSSA ANTHONY
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
1103TF0000XFamily Psychologist6851102940MI
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1336695352
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA ANTHONY
Provider Business Mailing Address
First Line : 1500 S DOUGLAS RD STE 230
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-4108
Country : US
Telephone Number : 844-854-1116
Fax Number :
Provider Business Practice Location Address
First Line : 31557 SCHOOLCRAFT RD STE 200
Second Line :
City : LIVONIA
State : MI
Zip : 48150-1848
Country : US
Telephone Number : 844-854-1116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2016
Last Update Date : 02/06/2023

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Directions to “ ALYSSA ANTHONY ” Practice Location

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