Provider Demographics
NPI:1205559648
Name:NEGRON, ALYSSA (LMHC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:NEGRON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CHANEY DR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-4533
Mailing Address - Country:US
Mailing Address - Phone:407-900-9632
Mailing Address - Fax:
Practice Address - Street 1:531 VERSAILLES DR STE 100
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4591
Practice Address - Country:US
Practice Address - Phone:407-900-9632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health