Provider Demographics
NPI:1346499381
Name:WYMAN PACIFIC, ALYSSA JAYNE (MSW)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:JAYNE
Last Name:WYMAN PACIFIC
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 VENUS DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1013
Mailing Address - Country:US
Mailing Address - Phone:781-264-1441
Mailing Address - Fax:
Practice Address - Street 1:23 VENUS DR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1013
Practice Address - Country:US
Practice Address - Phone:781-264-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1160941041C0700X
MAS20883105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional