Provider Demographics
NPI:1881328359
Name:MINNICK, ALYSSA (PHD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MINNICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:COMPEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:369 SWEDESFORD RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1603
Mailing Address - Country:US
Mailing Address - Phone:215-913-0044
Mailing Address - Fax:
Practice Address - Street 1:3535 MARKET ST FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3317
Practice Address - Country:US
Practice Address - Phone:215-573-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019630103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical