Provider Demographics
NPI:1881039303
Name:FARO, ALYSSA LEIGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:LEIGH
Last Name:FARO
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 1:23 ISAAC ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2080
Mailing Address - Country:US
Mailing Address - Phone:774-419-1169
Mailing Address - Fax:
Practice Address - Street 1:23 ISAAC ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2080
Practice Address - Country:US
Practice Address - Phone:774-419-1169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10830103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist