Provider Demographics
NPI:1194265298
Name:MAUTE, ALYSSA (MSED)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:MAUTE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:WIRTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1045 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2730
Mailing Address - Country:US
Mailing Address - Phone:315-425-1004
Mailing Address - Fax:
Practice Address - Street 1:1045 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2730
Practice Address - Country:US
Practice Address - Phone:315-425-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator