Provider Demographics
NPI:1467647131
Name:REED, ALISA MARIE (MC11151)
Entity Type:Individual
Prefix:MS
First Name:ALISA
Middle Name:MARIE
Last Name:REED
Suffix:
Gender:F
Credentials:MC11151
Other - Prefix:MRS
Other - First Name:ALISA
Other - Middle Name:MARIE REED
Other - Last Name:SOLOMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MC11151
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11959-0425
Mailing Address - Country:US
Mailing Address - Phone:207-329-0375
Mailing Address - Fax:
Practice Address - Street 1:99B MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2607
Practice Address - Country:US
Practice Address - Phone:207-329-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC111511041C0700X
NYR078727-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical