Provider Demographics
NPI:1104477660
Name:ROBERTS, ALYSSA (MA, NCC)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 OREGON RD
Mailing Address - Street 2:
Mailing Address - City:LEOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17540-9754
Mailing Address - Country:US
Mailing Address - Phone:717-661-3548
Mailing Address - Fax:
Practice Address - Street 1:1417 OREGON RD
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-9754
Practice Address - Country:US
Practice Address - Phone:717-661-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty