MEDICARE: ALISSA CLARICE D'ALESSANDRO MA, BCBA

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	103K00000X	Behavior Analyst		AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-25-83127	OTHER		BCBA CERTIFICATE

General Provider Information

NPI Number	:	1366940199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISSA CLARICE D'ALESSANDRO MA, BCBA

Provider Business Mailing Address
First Line	:	3500 DEPAUW BLVD STE 3070
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6135
Country	:	US
Telephone Number	:	855-324-0885
Fax Number	:	317-520-8200

Provider Business Practice Location Address
First Line	:	3377 S PRICE RD STE 115
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-3578
Country	:	US
Telephone Number	:	520-438-5588
Fax Number	:	317-520-8200

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

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	08/25/2025

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