Provider Demographics
NPI:1467081562
Name:KRAMER, ALISSA ANN (LGSW)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:ANN
Last Name:KRAMER
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:ANN
Other - Last Name:WILMOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:170 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1432
Mailing Address - Country:US
Mailing Address - Phone:304-290-5520
Mailing Address - Fax:
Practice Address - Street 1:295 HIGH ST STE 3
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5449
Practice Address - Country:US
Practice Address - Phone:304-363-4265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00939160104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker