Provider Demographics
NPI:1871883454
Name:CASAZZA, ALYSSA DAUDT (MT-BC, LCAT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:DAUDT
Last Name:CASAZZA
Suffix:
Gender:F
Credentials:MT-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1258
Mailing Address - Country:US
Mailing Address - Phone:973-287-6646
Mailing Address - Fax:
Practice Address - Street 1:11 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1258
Practice Address - Country:US
Practice Address - Phone:973-287-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
06771225A00000X
NY000752225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist