Provider Demographics
NPI:1972180768
Name:ALYSSA JOHNSON WELLNESS
Entity Type:Organization
Organization Name:ALYSSA JOHNSON WELLNESS
Other - Org Name:ALYSSA JOHNSON, LICSW
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRIVATE PRACTICE SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-577-4699
Mailing Address - Street 1:303 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1411
Mailing Address - Country:US
Mailing Address - Phone:508-577-4699
Mailing Address - Fax:
Practice Address - Street 1:303 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1411
Practice Address - Country:US
Practice Address - Phone:508-372-8482
Practice Address - Fax:508-213-3763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)