Provider Demographics
NPI:1306409941
Name:BALASCO, ALYSSA LAUREN (LCSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LAUREN
Last Name:BALASCO
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 1:5365 TOSCANA WAY APT 449
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5331
Mailing Address - Country:US
Mailing Address - Phone:401-556-9810
Mailing Address - Fax:
Practice Address - Street 1:5365 TOSCANA WAY APT 449
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5331
Practice Address - Country:US
Practice Address - Phone:401-556-9810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW89579101YM0800X
CA1132601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty