Provider Demographics
NPI:1770764094
Name:MCGRATH, ALYSSA BAILEY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:BAILEY
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 N JACKSON ST
Mailing Address - Street 2:THE RENAISSANCE CENTRE
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701
Mailing Address - Country:US
Mailing Address - Phone:229-889-7200
Mailing Address - Fax:229-889-7393
Practice Address - Street 1:506 N JACKSON ST
Practice Address - Street 2:THE RENAISSANCE CENTRE
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701
Practice Address - Country:US
Practice Address - Phone:229-889-7200
Practice Address - Fax:229-889-7393
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0038971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA812668869BMedicaid