Provider Demographics
NPI:1124406194
Name:BOOTH, ALAN (LMSW)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:BOOTH
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11846 228TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-2132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1370 BROADWAY
Practice Address - Street 2:#560
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7302
Practice Address - Country:US
Practice Address - Phone:718-419-3416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070460104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker