Provider Demographics
NPI:1699517920
Name:KERRIGAN, ALYSSA (PSYD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:BOLTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2504 VENETIAN CT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-7472
Mailing Address - Country:US
Mailing Address - Phone:561-703-7647
Mailing Address - Fax:
Practice Address - Street 1:12008 S SHORE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6396
Practice Address - Country:US
Practice Address - Phone:561-223-1066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12274103TC0700X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical