Provider Demographics
NPI:1851395206
Name:ALESSI, MARYCELY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARYCELY
Middle Name:
Last Name:ALESSI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 LOUISIANA AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2341
Mailing Address - Country:US
Mailing Address - Phone:407-629-4356
Mailing Address - Fax:407-629-1812
Practice Address - Street 1:1155 LOUISIANA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2341
Practice Address - Country:US
Practice Address - Phone:407-629-4356
Practice Address - Fax:407-629-1812
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002569174400000X
FLPY 7566103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0009510794AMedicaid