Active NPI
Alissa Beth Jerud, PHD
- Clinical Psychologist
- Philadelphia, PA
National Provider Identifier
1508340720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS018588
- Practice address
- 4618 Hazel Ave
Philadelphia, PA 19143-2104 - Phone
- (206) 501-8794
- NPI assigned
- Sep 24, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS018588 | PA | Primary |
Addresses
Primary practice location
4618 Hazel Ave
Philadelphia, PA 19143-2104
Mailing address
4618 Hazel Ave
Philadelphia, PA 19143-2104
Phone (206) 501-8794
Other names 1
- Alissa Beth Worly
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 25, 2020 through Jul 25, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS018588 | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537747200000",
"number": "1508340720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4618 HAZEL AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191432104",
"telephone_number": "206-501-8794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4618 HAZEL AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191432104",
"telephone_number": "206-501-8794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JERUD",
"first_name": "ALISSA",
"middle_name": "BETH",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-24",
"last_updated": "2018-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS018588",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ALISSA",
"last_name": "WORLY",
"middle_name": "BETH",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.