Provider Demographics
NPI:1548762271
Name:AMMERMAN, ALYSSA MAE (LCSW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MAE
Last Name:AMMERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:NY
Mailing Address - Zip Code:14485-0023
Mailing Address - Country:US
Mailing Address - Phone:585-471-2998
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 23
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:NY
Practice Address - Zip Code:14485-0023
Practice Address - Country:US
Practice Address - Phone:585-471-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0994471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical