Provider Demographics
NPI:1346212198
Name:PSIRAKIS, ALICE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:PSIRAKIS
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 1:8701 MIDLAND PKWY
Mailing Address - Street 2:3D
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4751
Mailing Address - Country:US
Mailing Address - Phone:347-731-1546
Mailing Address - Fax:609-562-4935
Practice Address - Street 1:5250 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:FORT DIX
Practice Address - State:NJ
Practice Address - Zip Code:08640-5017
Practice Address - Country:US
Practice Address - Phone:609-562-3141
Practice Address - Fax:609-562-4935
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059660104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker