Provider Demographics
NPI:1033625934
Name:PICANO, ALYSSA MONIQUE (RBT)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:MONIQUE
Last Name:PICANO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:MONIQUE
Other - Last Name:MENDIOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:3485 RUFFIN RD APT 2J
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2518
Mailing Address - Country:US
Mailing Address - Phone:951-775-4339
Mailing Address - Fax:
Practice Address - Street 1:3914 MURPHY CANYON RD STE A120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4457
Practice Address - Country:US
Practice Address - Phone:951-813-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-15-09173106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician