Provider Demographics
NPI:1386010270
Name:PSIUK, ALISON (MA)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:PSIUK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2115
Mailing Address - Country:US
Mailing Address - Phone:732-910-7948
Mailing Address - Fax:
Practice Address - Street 1:1711 OREGON ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2115
Practice Address - Country:US
Practice Address - Phone:732-910-7948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF81658106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist