Provider Demographics
NPI:1407059082
Name:HOOPER, ALNETTA LYSHAWN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALNETTA
Middle Name:LYSHAWN
Last Name:HOOPER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 E RIDGEWOOD AVE
Mailing Address - Street 2:PMB 212
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3808
Mailing Address - Country:US
Mailing Address - Phone:201-736-0867
Mailing Address - Fax:866-724-3471
Practice Address - Street 1:38 E RIDGEWOOD AVE
Practice Address - Street 2:PMB 212
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3808
Practice Address - Country:US
Practice Address - Phone:201-736-0867
Practice Address - Fax:866-724-3471
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00412300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083213Medicare ID - Type Unspecified