Provider Demographics
NPI:1346481587
Name:STEIN, ALYSSA T (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:T
Last Name:STEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 PROVIDENT CREEK CT
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-7775
Mailing Address - Country:US
Mailing Address - Phone:516-987-0772
Mailing Address - Fax:
Practice Address - Street 1:12701 TOWNEPARK WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2384
Practice Address - Country:US
Practice Address - Phone:502-254-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069325104100000X
KY50231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker