Provider Demographics
NPI:1427887355
Name:GOFF, ALYSSA (LMHC, R-DMT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GOFF
Suffix:
Gender:F
Credentials:LMHC, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 HOLLISTON ST
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1427
Mailing Address - Country:US
Mailing Address - Phone:508-619-1485
Mailing Address - Fax:
Practice Address - Street 1:82 HOLLISTON ST
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1427
Practice Address - Country:US
Practice Address - Phone:603-218-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 221700000X
MA10002784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist