Provider Demographics
NPI:1902573587
Name:GAJAR, ALYSSA (LMSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GAJAR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HOGBACK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9735
Mailing Address - Country:US
Mailing Address - Phone:734-386-0041
Mailing Address - Fax:
Practice Address - Street 1:2000 HOGBACK RD STE 2
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9735
Practice Address - Country:US
Practice Address - Phone:734-386-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011171841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical