Provider Demographics
NPI:1134281694
Name:MALLOW, ALISSA (DSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:
Last Name:MALLOW
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BRIDLE CT
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1207
Mailing Address - Country:US
Mailing Address - Phone:516-526-8318
Mailing Address - Fax:
Practice Address - Street 1:6 BRIDLE CT
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1207
Practice Address - Country:US
Practice Address - Phone:516-526-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NYR303231041C0700X
NY0303231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical