Provider Demographics
NPI:1588684385
Name:ALTER, DAISY EDMONDSON (PHD)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:EDMONDSON
Last Name:ALTER
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 1:154 SLOCUM CRES
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5248
Mailing Address - Country:US
Mailing Address - Phone:718-986-5258
Mailing Address - Fax:
Practice Address - Street 1:10923 71ST RD
Practice Address - Street 2:APARTMENT 1H
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4849
Practice Address - Country:US
Practice Address - Phone:718-986-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015375103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06437Medicare ID - Type Unspecified