Individual
ALYSA M GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9 SAN BARTOLA DR, ST AUGUSTINE, FL 32086-5767
(904) 825-4500
(904) 825-3672
Mailing address
7015 A C SKINNER PKWY STE 1, JACKSONVILLE, FL 32256-6932
(904) 363-2113
(904) 363-2606
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW16136
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
882F4
FL BLUE
FL
01
—
LU495
MEDICARE
FL
Enumeration date
08/27/2019
Last updated
10/24/2019
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