Provider Demographics
NPI:1043808769
Name:KISS, ALICIA HALENA (MHC-LP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:HALENA
Last Name:KISS
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3309
Mailing Address - Country:US
Mailing Address - Phone:929-323-6637
Mailing Address - Fax:
Practice Address - Street 1:285 LEXINGTON AVE STE A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3569
Practice Address - Country:US
Practice Address - Phone:347-460-8572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health