Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 102L00000X | Psychologist | 61071463 | WA |
Y | 103T00000X | Psychologist | 61071463 | WA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 61071463 | WA |
NPI | 1609353622 |
---|---|
Provider Name | Alyssa M Ramirez |
First Address | Madison, WI 53711-6227 |
Second Address | Madison, WI 53711-6227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2018 |
Last Update Date | 22/04/2021 |