Provider Demographics
NPI:1003354200
Name:ALLOTTA, ALYSSA (LSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:ALLOTTA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:MANCINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:140 GUNWALE RD
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-5006
Mailing Address - Country:US
Mailing Address - Phone:609-891-9422
Mailing Address - Fax:
Practice Address - Street 1:140 GUNWALE RD
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-5006
Practice Address - Country:US
Practice Address - Phone:609-891-9422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06084600101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor