Provider Demographics
NPI:1376221002
Name:MYER, ALISSA
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:MYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16340 ROSCOE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406
Mailing Address - Country:US
Mailing Address - Phone:323-544-5462
Mailing Address - Fax:
Practice Address - Street 1:16340 ROSCOE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1217
Practice Address - Country:US
Practice Address - Phone:818-302-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW842931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical