Provider Demographics
NPI:1033754684
Name:SMYTH, ALYSSA
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SMYTH
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:NAVAL MEDICAL READINESS TRAINING UNIT DAHLGREN
Mailing Address - Street 2:17457 CAFFEE RD
Mailing Address - City:DAHLGREN
Mailing Address - State:VA
Mailing Address - Zip Code:22448
Mailing Address - Country:US
Mailing Address - Phone:540-653-2276
Mailing Address - Fax:
Practice Address - Street 1:NAVAL MEDICAL READINESS TRAINING UNIT DAHLGREN
Practice Address - Street 2:17457 CAFFEE RD
Practice Address - City:DAHLGREN
Practice Address - State:VA
Practice Address - Zip Code:22448
Practice Address - Country:US
Practice Address - Phone:540-653-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007229103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical