MEDICARE: ALYSSA FRANCESCA BELCASTRO

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	1-20-42657

General Provider Information

NPI Number	:	1770040719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA FRANCESCA BELCASTRO

Provider Business Mailing Address
First Line	:	117 NORWALK AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5658
Country	:	US
Telephone Number	:	917-902-7829
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 NORWALK AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5658
Country	:	US
Telephone Number	:	917-902-7829
Fax Number	:

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

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	07/21/2020

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