Provider Demographics
NPI:1952161937
Name:VERRIGNI, ALYSSA
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:VERRIGNI
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 1:15610 TUSTIN VILLAGE WAY APT 43
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4984
Mailing Address - Country:US
Mailing Address - Phone:949-351-7490
Mailing Address - Fax:
Practice Address - Street 1:1202 W CIVIC CENTER DR STE 205
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2251
Practice Address - Country:US
Practice Address - Phone:714-245-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-05-28
Deactivation Date:2024-03-24
Deactivation Code:
Reactivation Date:2024-05-28
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist