Provider Demographics
NPI:1497564488
Name:MAWSON, ALYSSA J
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:J
Last Name:MAWSON
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 1:142 COONEY RD
Mailing Address - Street 2:
Mailing Address - City:POMFRET CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06259-2232
Mailing Address - Country:US
Mailing Address - Phone:860-420-7286
Mailing Address - Fax:
Practice Address - Street 1:10 LINCOLN SQ
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1135
Practice Address - Country:US
Practice Address - Phone:508-890-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program