Provider Demographics
NPI:1194435537
Name:AXELROD, ALYSSA (MASTERS ARTS THERAPY)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:AXELROD
Suffix:
Gender:F
Credentials:MASTERS ARTS THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1317
Mailing Address - Country:US
Mailing Address - Phone:516-371-1939
Mailing Address - Fax:
Practice Address - Street 1:264 BEACH 19TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4431
Practice Address - Country:US
Practice Address - Phone:718-868-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist