Provider Demographics
NPI:1780354811
Name:STECKLER, ALYSSA
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:
Last Name:STECKLER
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 1:310 S DILLARD ST STE 190
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3567
Mailing Address - Country:US
Mailing Address - Phone:407-347-0661
Mailing Address - Fax:407-347-0664
Practice Address - Street 1:310 S DILLARD ST STE 190
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3567
Practice Address - Country:US
Practice Address - Phone:407-347-0661
Practice Address - Fax:407-347-0664
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11068103T00000X, 103TC0700X
103TB0200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling