Provider Demographics
NPI:1366502239
Name:CRISAFULLI, ALIDA (PHD, LCSW-R)
Entity Type:Individual
Prefix:DR
First Name:ALIDA
Middle Name:
Last Name:CRISAFULLI
Suffix:
Gender:F
Credentials:PHD, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 NEW SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1129
Mailing Address - Country:US
Mailing Address - Phone:518-487-4007
Mailing Address - Fax:518-729-3240
Practice Address - Street 1:878 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1129
Practice Address - Country:US
Practice Address - Phone:518-487-4007
Practice Address - Fax:518-729-3240
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041108-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical