Provider Demographics
NPI:1386852655
Name:NOVEMBER, ALYSE (PHD, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALYSE
Middle Name:
Last Name:NOVEMBER
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 LUMPKIN ST
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-1983
Mailing Address - Country:US
Mailing Address - Phone:561-289-2545
Mailing Address - Fax:561-270-2284
Practice Address - Street 1:7000 W PALMETTO PARK RD STE 201
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3430
Practice Address - Country:US
Practice Address - Phone:561-270-2280
Practice Address - Fax:561-270-2284
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW76051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ131WOtherBLUE CROSS BLUE SHIELD FL
FLAF095OtherMEDICARE