Provider Demographics
NPI:1992421887
Name:TODTENKOPF, ALYSE HOPE
Entity type:Individual
Prefix:
First Name:ALYSE
Middle Name:HOPE
Last Name:TODTENKOPF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 STEPHEN WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-1597
Mailing Address - Country:US
Mailing Address - Phone:508-422-6818
Mailing Address - Fax:
Practice Address - Street 1:133 BELCHERTOWN RD APT 20
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2674
Practice Address - Country:US
Practice Address - Phone:508-422-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALKA960142206OtherBLUE CROSS