Provider Demographics
NPI:1487956645
Name:BURCHILL, ALYSON (MS)
Entity type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:
Last Name:BURCHILL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 WALTHAM ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8033
Mailing Address - Country:US
Mailing Address - Phone:781-761-5077
Mailing Address - Fax:
Practice Address - Street 1:1040 WALTHAM ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-8033
Practice Address - Country:US
Practice Address - Phone:781-761-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-21
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303287Medicaid
MA1303287OtherMBHP
MAM18633OtherBCBS
MA042611055OtherTAX ID
MA99618201OtherNETWORKHEALTH
MA0000023532OtherBMC
MA1004745OtherNPH
MA1004745OtherNPH