Provider Demographics
NPI:1992960041
Name:BRYCZKOWSKI-FORDIN, ALESSANA (LMHC)
Entity type:Individual
Prefix:MS
First Name:ALESSANA
Middle Name:
Last Name:BRYCZKOWSKI-FORDIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 SW 3RD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-3000
Mailing Address - Country:US
Mailing Address - Phone:305-915-5748
Mailing Address - Fax:
Practice Address - Street 1:2121 SW 3RD AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-3000
Practice Address - Country:US
Practice Address - Phone:305-915-5748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health