Provider Demographics
NPI:1023625993
Name:MALSBURY, ALLISYN MARIE
Entity type:Individual
Prefix:
First Name:ALLISYN
Middle Name:MARIE
Last Name:MALSBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDER
Other - Middle Name:WILLIAM
Other - Last Name:ANDRESON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2317 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-4127
Mailing Address - Country:US
Mailing Address - Phone:504-322-0193
Mailing Address - Fax:
Practice Address - Street 1:4201 N I 10 SERVICE RD W
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6713
Practice Address - Country:US
Practice Address - Phone:877-418-2978
Practice Address - Fax:866-500-2186
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician