Provider Demographics
NPI:1053311803
Name:LEFTIN, ALYSON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALYSON
Middle Name:
Last Name:LEFTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6136 FRISCO SQUARE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3251
Mailing Address - Country:US
Mailing Address - Phone:214-669-3751
Mailing Address - Fax:
Practice Address - Street 1:6136 FRISCO SQUARE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3251
Practice Address - Country:US
Practice Address - Phone:214-669-3751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00461OtherTX LICENSE
TX0067MROtherBLUE CROSS
TX4103145OtherAETNA
TX4103145OtherAETNA