Provider Demographics
NPI:1558571877
Name:STAUBER, ALLIDA (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALLIDA
Middle Name:
Last Name:STAUBER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MS
Other - First Name:ALLIDA
Other - Middle Name:
Other - Last Name:STAUBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:95 OLIVER RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506-1506
Mailing Address - Country:US
Mailing Address - Phone:914-234-7628
Mailing Address - Fax:
Practice Address - Street 1:95 OLIVER RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NY
Practice Address - Zip Code:10506-1506
Practice Address - Country:US
Practice Address - Phone:914-815-5285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0173771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical