Provider Demographics
NPI:1083229207
Name:DEFRANCISCO, ALYSIA MARIE
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:MARIE
Last Name:DEFRANCISCO
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 1:751 E DAILY DR STE 310
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6077
Mailing Address - Country:US
Mailing Address - Phone:805-445-7800
Mailing Address - Fax:
Practice Address - Street 1:751 E DAILY DR STE 310
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6077
Practice Address - Country:US
Practice Address - Phone:805-445-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2023-06-23
Deactivation Date:2021-04-12
Deactivation Code:
Reactivation Date:2022-08-29
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103T00000X, 390200000X
CAPSB94026578103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program