Provider Demographics
NPI:1508315649
Name:ALBRIGHT, DESIREE (LMHC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:ALBRIGHT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:131 CLAYTON MANOR DR S APT 4
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5797
Mailing Address - Country:US
Mailing Address - Phone:315-313-2421
Mailing Address - Fax:
Practice Address - Street 1:131 CLAYTON MANOR DR S APT 4
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5797
Practice Address - Country:US
Practice Address - Phone:315-313-2421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1508898321Medicaid