Provider Demographics
NPI:1548762271
Name:AMMERMAN, ALYSSA MAE (LMSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MAE
Last Name:AMMERMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MILLENNIUM DR
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-1197
Mailing Address - Country:US
Mailing Address - Phone:852-437-2505
Mailing Address - Fax:
Practice Address - Street 1:4600 MILLENNIUM DR
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1197
Practice Address - Country:US
Practice Address - Phone:585-243-7250
Practice Address - Fax:585-243-7264
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103526-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker