Provider Demographics
NPI:1184213654
Name:MARTIGNETTI, ALYSSA (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MARTIGNETTI
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 BAY SHORE CT
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3755
Mailing Address - Country:US
Mailing Address - Phone:732-449-5470
Mailing Address - Fax:
Practice Address - Street 1:1722 BAY SHORE CT
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3755
Practice Address - Country:US
Practice Address - Phone:732-449-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06576300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker