Provider Demographics
NPI:1124669353
Name:COSENTINO, ALYSSA MARIE (LSW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:COSENTINO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 DUNLAP LN APT L
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-7050
Mailing Address - Country:US
Mailing Address - Phone:732-766-4512
Mailing Address - Fax:
Practice Address - Street 1:2501 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1904
Practice Address - Country:US
Practice Address - Phone:717-782-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-29
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135830104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker