Provider Demographics
NPI:1932973898
Name:STREETER, ALYSIA E
Entity Type:Individual
Prefix:MS
First Name:ALYSIA
Middle Name:E
Last Name:STREETER
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 1:14341 DELMAR ST # A
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-3518
Mailing Address - Country:US
Mailing Address - Phone:813-836-5033
Mailing Address - Fax:
Practice Address - Street 1:14341 DELMAR ST # A
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-3518
Practice Address - Country:US
Practice Address - Phone:813-836-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X, 1041C0700X, 1041S0200X
FL104100000X104100000X
FL1041S0200X1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical