Provider Demographics
NPI:1134652084
Name:RICHARDS, ALYSSA CEARA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CEARA
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISSY
Other - Middle Name:
Other - Last Name:NAVANTU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1044 STERLING PL UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2501
Mailing Address - Country:US
Mailing Address - Phone:917-310-0411
Mailing Address - Fax:
Practice Address - Street 1:1044 STERLING PL UNIT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2501
Practice Address - Country:US
Practice Address - Phone:917-310-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098580104100000X
NY089227-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY089227-01OtherNEW YORK STATE OFFICE OF PROFESSIONS