Provider Demographics
NPI:1609495779
Name:ALIAZZO, ALISON
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:ALIAZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 95TH ST APT 19M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4091
Mailing Address - Country:US
Mailing Address - Phone:917-882-6680
Mailing Address - Fax:
Practice Address - Street 1:535 5TH AVE FL 16
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3689
Practice Address - Country:US
Practice Address - Phone:917-882-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107048-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY107048-01OtherLICENSED MASTER SOCIAL WORKER