Provider Demographics
NPI:1710595293
Name:HAINES, ALYSSA JENNIFER (BSL)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:JENNIFER
Last Name:HAINES
Suffix:
Gender:F
Credentials:BSL
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:JENNIFER
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:170 PHEASANT RUN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1877
Mailing Address - Country:US
Mailing Address - Phone:215-579-0670
Mailing Address - Fax:215-579-6960
Practice Address - Street 1:170 PHEASANT RUN
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1877
Practice Address - Country:US
Practice Address - Phone:215-579-0670
Practice Address - Fax:215-579-6960
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004922103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA601544483Medicaid