Alyssa Jeannette Axelrod, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

11167 Issued in CT

Practice address

17 Blakeslee Rd
Wallingford, CT 06492-5212

Phone

(203) 868-1853

NPI assigned

Dec 16, 2018

Last updated

Aug 31, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: alyssa.axelrod.p1@direct.wheelerclinic.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alyssa Axelrod LCSW LLC

  • Adult Mental Health Clinic/Center
  • Wallingford, CT
  • NPI 1154042208
  NPD Authorized official
• Apple Valley Behavioral Health LLC

  • Professional Counselor
  • Plantsville, CT
  • NPI 1568843456
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1114498268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 BLAKESLEE RD",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064925212",
            "telephone_number": "203-868-1853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 BLAKESLEE RD",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064925212",
            "telephone_number": "203-868-1853"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "43 Woodland St",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061052363",
            "country_code": "US",
            "telephone_number": "203-868-1853",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "791 S Main St",
            "address_purpose": "LOCATION",
            "city": "Plantsville",
            "state": "CT",
            "postal_code": "064791519",
            "country_code": "US",
            "telephone_number": "860-378-8090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AXELROD",
        "first_name": "ALYSSA",
        "middle_name": "JEANNETTE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-16",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CT",
            "license": "11167",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "11167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aspire Family Medicine &Wellness Center, LLC
• Dylan Jared Assael, MD
• Neslyne Belinda Augustin, MD
• Karen E Austin, PT
• Authentically You Counseling and Arts LLC
• Alfredo Luis Axtmayer, MD
• Alexander Baaklini, DO
• Back on Course LLC
• Balanced Life Counseling LLC
• Balanced Nutrition LLC

• Clinical Social Worker in Wallingford, CT
• Providers in Wallingford, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.