Provider Demographics
NPI:1457085292
Name:MEMMELAAR, ALYSHA TAYLOR (LMSW)
Entity Type:Individual
Prefix:
First Name:ALYSHA
Middle Name:TAYLOR
Last Name:MEMMELAAR
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 1:20 CRYSTAL ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1380
Mailing Address - Country:US
Mailing Address - Phone:845-707-4326
Mailing Address - Fax:845-707-4398
Practice Address - Street 1:20 CRYSTAL ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1380
Practice Address - Country:US
Practice Address - Phone:845-707-4326
Practice Address - Fax:845-707-4398
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1636463104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker