Provider Demographics
NPI:1124693320
Name:GIAMPOLO, ALYSSA (BT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GIAMPOLO
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WILLS WAY
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3770
Mailing Address - Country:US
Mailing Address - Phone:732-646-8774
Mailing Address - Fax:855-940-0177
Practice Address - Street 1:30 WILLS WAY
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3770
Practice Address - Country:US
Practice Address - Phone:732-646-8774
Practice Address - Fax:855-940-0177
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-21-178922106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician