Provider Demographics
NPI:1659627503
Name:MARTIN, ALYSSA STACY (BS)
Entity Type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:STACY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CHERRY ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2608
Mailing Address - Country:US
Mailing Address - Phone:508-521-1020
Mailing Address - Fax:
Practice Address - Street 1:56 CHERRY ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2608
Practice Address - Country:US
Practice Address - Phone:508-521-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor