Provider Demographics
NPI:1326752098
Name:ROSS, ALLAIRE HEISIG (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ALLAIRE
Middle Name:HEISIG
Last Name:ROSS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WOOD LN
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-1628
Mailing Address - Country:US
Mailing Address - Phone:516-306-7566
Mailing Address - Fax:
Practice Address - Street 1:330 W 58TH ST STE 304
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1801
Practice Address - Country:US
Practice Address - Phone:212-933-4792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1174121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical