Provider Demographics
NPI:1497706014
Name:FREDA-COLON, ALYSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALYSE
Middle Name:
Last Name:FREDA-COLON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WOODRUFF CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2355
Mailing Address - Country:US
Mailing Address - Phone:631-271-0712
Mailing Address - Fax:
Practice Address - Street 1:410 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1541
Practice Address - Country:US
Practice Address - Phone:516-635-4848
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048909-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical