Alyssa Kimbrough

Primary specialty

Social WorkerTaxonomy code 104100000X

License

44SL06355600 Issued in NJ

Practice address

255 Winans Ave
Hillside, NJ 07205-1448

Phone

(908) 868-7784

NPI assigned

Dec 19, 2019

Reactivated

Mar 9, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1576713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1902444946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 WINANS AVE",
            "city": "HILLSIDE",
            "state": "NJ",
            "postal_code": "072051448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 WINANS AVE",
            "city": "HILLSIDE",
            "state": "NJ",
            "postal_code": "072051448",
            "telephone_number": "908-868-7784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBROUGH",
        "first_name": "ALYSSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-19",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "deactivation_date": "2022-05-25",
        "reactivation_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SL06355600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LSW",
            "identifier": "44SL06355600",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Ihavenoendpoint",
            "affiliation": "N",
            "address_1": "255 Winans Ave",
            "city": "Hillside",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "072051448",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Sarah Krause, DMD
• Cliff Gus Lachapelle
• Alan Lawrence

• Social Worker in Hillside, NJ
• Providers in Hillside, NJ by specialty
• Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; 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.