Provider Demographics
NPI:1326767112
Name:BASILIERE, ALYSSA KATHLEEN (LICSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KATHLEEN
Last Name:BASILIERE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:KATHLEEN
Other - Last Name:CUDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 BONANZA PARK
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-6777
Mailing Address - Country:US
Mailing Address - Phone:978-886-8151
Mailing Address - Fax:
Practice Address - Street 1:52 COMMUNITY LN
Practice Address - Street 2:
Practice Address - City:SOUTH HERO
Practice Address - State:VT
Practice Address - Zip Code:05486-4418
Practice Address - Country:US
Practice Address - Phone:802-540-1764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01346921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical