Provider Demographics
NPI:1629679691
Name:MORRON, ALYSSA ANN (RD, CLC, CLSP)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:ANN
Last Name:MORRON
Suffix:
Gender:F
Credentials:RD, CLC, CLSP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:ANN
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD-N, LDN
Mailing Address - Street 1:15 PROSPECT STREET
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01568
Mailing Address - Country:US
Mailing Address - Phone:860-966-4801
Mailing Address - Fax:
Practice Address - Street 1:1 RANDALL SQUARE
Practice Address - Street 2:SUITE 302
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-443-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001168133V00000X
MA4541133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
331894OtherCERTIFIED LACTATION COUNSELOR
1011286OtherREGISTERED DIETITIAN