Provider Demographics
NPI:1053033159
Name:DECASTRO, ALLYSON NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:NICOLE
Last Name:DECASTRO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:NICOLE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3555 COMMONWEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-3119
Mailing Address - Country:US
Mailing Address - Phone:850-575-6422
Mailing Address - Fax:
Practice Address - Street 1:3555 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-3119
Practice Address - Country:US
Practice Address - Phone:850-575-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW188031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical