Provider Demographics
NPI:1679818165
Name:CASCIOTTA, ALYSSA MAE (PSYD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MAE
Last Name:CASCIOTTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MAE
Other - Last Name:WEINZAPFEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:7300 E INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2794
Mailing Address - Country:US
Mailing Address - Phone:812-401-8008
Mailing Address - Fax:812-401-8201
Practice Address - Street 1:7300 E INDIANA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2794
Practice Address - Country:US
Practice Address - Phone:812-401-8008
Practice Address - Fax:812-401-8201
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043061A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20043061AOtherLICENSE