MEDICARE: ALYSSA GIBSON I

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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1437098050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA GIBSON I

Provider Business Mailing Address
First Line	:	3 GREAT BROOK VALLEY AVE APT 3
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01605-3556
Country	:	US
Telephone Number	:	617-855-1954
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 S EAST ST
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002-2406
Country	:	US
Telephone Number	:	617-855-1954
Fax Number	:

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

Provider Enumeration Date	:	03/27/2026
Last Update Date	:	03/27/2026

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Directions to “ ALYSSA GIBSON I ” Practice Location

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