Provider Demographics
NPI:1144691742
Name:CHEN, ALYSSA MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:CHEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MARIE
Other - Last Name:GAROFALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 748519
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8519
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:
Practice Address - Street 1:836 PRUDENTIAL DR STE 1006
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8337
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10076103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical