Provider Demographics
NPI:1467296038
Name:ROBERTSON, ALYSSA ROSE
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:ROSE
Last Name:ROBERTSON
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 1:324 CONEY ST
Mailing Address - Street 2:
Mailing Address - City:EAST WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02032-1507
Mailing Address - Country:US
Mailing Address - Phone:508-269-4636
Mailing Address - Fax:
Practice Address - Street 1:12 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-4130
Practice Address - Country:US
Practice Address - Phone:508-422-0242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program