Provider Demographics
NPI:1316779259
Name:NEGRON, ALYSSA MELODY (LMSW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MELODY
Last Name:NEGRON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 NEPPERHAN AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1049
Mailing Address - Country:US
Mailing Address - Phone:347-553-8628
Mailing Address - Fax:
Practice Address - Street 1:1465 NEPPERHAN AVE APT 3B
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1049
Practice Address - Country:US
Practice Address - Phone:347-553-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121946-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker