Provider Demographics
NPI:1821760133
Name:WYMAN, ALYSSA (LICSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:WYMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CAPITAL PLZ STE 403
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4911
Mailing Address - Country:US
Mailing Address - Phone:603-270-9181
Mailing Address - Fax:
Practice Address - Street 1:2 CAPITAL PLZ STE 403
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4911
Practice Address - Country:US
Practice Address - Phone:603-270-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH25341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical