Provider Demographics
NPI:1336913144
Name:FALLER, ALYSSA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:FALLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:MARCHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8429 HORIZON CT
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-3648
Mailing Address - Country:US
Mailing Address - Phone:708-250-9658
Mailing Address - Fax:
Practice Address - Street 1:2081 CALISTOGA DR
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-4831
Practice Address - Country:US
Practice Address - Phone:815-320-2410
Practice Address - Fax:815-425-7123
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490242361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical