Provider Demographics
NPI:1164991451
Name:KONDOR, ALYSSA ASHLY (LCSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ASHLY
Last Name:KONDOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:ASHLY
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:27 HUNTERS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1114
Mailing Address - Country:US
Mailing Address - Phone:203-556-2030
Mailing Address - Fax:
Practice Address - Street 1:189 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2014
Practice Address - Country:US
Practice Address - Phone:203-937-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT115591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical