Provider Demographics
NPI:1518261601
Name:GUMAER, ALISA BETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:BETH
Last Name:GUMAER
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 1:2025 ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12143-0150
Mailing Address - Country:US
Mailing Address - Phone:518-756-5200
Mailing Address - Fax:
Practice Address - Street 1:2025 US ROUTE 9W
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143-9000
Practice Address - Country:US
Practice Address - Phone:518-756-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0805301041C0700X
NY4731411011041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical