Provider Demographics
NPI:1528601036
Name:WILLIAMS, ALYSSA SUSAN (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:SUSAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:SUSAN
Other - Last Name:BOGACKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25500 POINT LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2015
Mailing Address - Country:US
Mailing Address - Phone:301-475-6227
Mailing Address - Fax:301-475-6169
Practice Address - Street 1:25500 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2015
Practice Address - Country:US
Practice Address - Phone:301-475-6227
Practice Address - Fax:301-475-6169
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR215583363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health