Provider Demographics
NPI:1033701644
Name:RAINE, ALYSSA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:
Last Name:RAINE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20 PINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-1404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 WOOD RD
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-2245
Practice Address - Country:US
Practice Address - Phone:518-884-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111498104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker