Provider Demographics
NPI:1508250077
Name:MASS, ALYSSA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:MASS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 PACIFIC AVE APT 701
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-2399
Mailing Address - Country:US
Mailing Address - Phone:310-702-6734
Mailing Address - Fax:
Practice Address - Street 1:3150 18TH ST STE 501
Practice Address - Street 2:MAILBOX 119
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2077
Practice Address - Country:US
Practice Address - Phone:310-702-6734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT82434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist