Provider Demographics
NPI:1578970448
Name:TEBBETT-MOCK, ALISON ANN (PHD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:ANN
Last Name:TEBBETT-MOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7559 263RD ST
Mailing Address - Street 2:BEHAVIORAL HEALTH PAVILION, 1 WEST
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1150
Mailing Address - Country:US
Mailing Address - Phone:718-470-5738
Mailing Address - Fax:
Practice Address - Street 1:7559 263RD ST
Practice Address - Street 2:BEHAVIORAL HEALTH PAVILION, 1 WEST
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1150
Practice Address - Country:US
Practice Address - Phone:718-470-5738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-12
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020673103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist