Provider Demographics
NPI:1891326211
Name:AGUIRRE, ALYSSA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17431 N 71ST DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8598
Mailing Address - Country:US
Mailing Address - Phone:623-680-3469
Mailing Address - Fax:623-248-3389
Practice Address - Street 1:17431 N 71ST DR STE 101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8598
Practice Address - Country:US
Practice Address - Phone:623-680-3469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058706001041C0700X
AZLCSW-192601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical