Provider Demographics
NPI:1790448835
Name:MONCIBAIZ, ALYSSA RIVERA (ASW)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:RIVERA
Last Name:MONCIBAIZ
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-3638
Mailing Address - Country:US
Mailing Address - Phone:559-627-1490
Mailing Address - Fax:
Practice Address - Street 1:711 N COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-3638
Practice Address - Country:US
Practice Address - Phone:559-627-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW102308101YM0800X, 104100000X
CA1023081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical