Provider Demographics
NPI:1124590591
Name:BOARDMAN, ALYSSA KAY (LMHC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KAY
Last Name:BOARDMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2824
Mailing Address - Country:US
Mailing Address - Phone:617-595-6651
Mailing Address - Fax:
Practice Address - Street 1:43 BROAD ST STE B
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-1977
Practice Address - Country:US
Practice Address - Phone:401-596-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01002101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health