Provider Demographics
NPI:1710508171
Name:DEAKYNE, ALYSON (LCSW)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:DEAKYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 OLIVER CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-6833
Mailing Address - Country:US
Mailing Address - Phone:505-235-1895
Mailing Address - Fax:
Practice Address - Street 1:903 5TH ST # C
Practice Address - Street 2:
Practice Address - City:ESTANCIA
Practice Address - State:NM
Practice Address - Zip Code:87016-1155
Practice Address - Country:US
Practice Address - Phone:505-384-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-112061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical