Provider Demographics
NPI:1710182415
Name:BAROSIN, ALISSA GILDE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:GILDE
Last Name:BAROSIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26 OAK POINT DR S
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-1122
Mailing Address - Country:US
Mailing Address - Phone:516-741-8299
Mailing Address - Fax:516-628-1750
Practice Address - Street 1:436 WILLIS AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2240
Practice Address - Country:US
Practice Address - Phone:516-741-8299
Practice Address - Fax:516-628-1750
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012724103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical