Provider Demographics
NPI:1710315502
Name:BIRDSALL, ANNALISA (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANNALISA
Middle Name:
Last Name:BIRDSALL
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 5TH AVE RM 802
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7721
Mailing Address - Country:US
Mailing Address - Phone:917-655-4924
Mailing Address - Fax:
Practice Address - Street 1:220 5TH AVE RM 802
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7721
Practice Address - Country:US
Practice Address - Phone:917-655-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001035106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist