Provider Demographics
NPI:1063889426
Name:MAIRANZ, ALYSSA B (LMHC)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:B
Last Name:MAIRANZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MADISON SQUARE WEST, FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3454
Mailing Address - Country:US
Mailing Address - Phone:516-229-1386
Mailing Address - Fax:
Practice Address - Street 1:16 MADISON SQUARE WEST, FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3454
Practice Address - Country:US
Practice Address - Phone:516-229-1386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health