Provider Demographics
NPI:1730645151
Name:ROSENBERG, ALYSSA BROOKE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:BROOKE
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:BROOKE
Other - Last Name:MCKEEFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:310 TAPPAN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-5346
Mailing Address - Country:US
Mailing Address - Phone:631-332-2197
Mailing Address - Fax:
Practice Address - Street 1:310 TAPPAN ST APT 4
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-5346
Practice Address - Country:US
Practice Address - Phone:631-332-2197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty