Provider Demographics
NPI:1275552515
Name:SEPTIMUS, ALIZA (PSYD)
Entity Type:Individual
Prefix:
First Name:ALIZA
Middle Name:
Last Name:SEPTIMUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2730
Mailing Address - Country:US
Mailing Address - Phone:516-569-9035
Mailing Address - Fax:
Practice Address - Street 1:553 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2200
Practice Address - Country:US
Practice Address - Phone:516-983-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013945-1103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02487832Medicaid
NY02487832Medicaid