Provider Demographics
NPI:1881678019
Name:NYDICK HALLER, ALISON SUSAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:SUSAN
Last Name:NYDICK HALLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ALISON
Other - Middle Name:SUSAN
Other - Last Name:NYDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3 E PEMBROKE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-5644
Mailing Address - Country:US
Mailing Address - Phone:845-765-2269
Mailing Address - Fax:845-765-2268
Practice Address - Street 1:1068 MAIN ST
Practice Address - Street 2:STE 104
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3659
Practice Address - Country:US
Practice Address - Phone:845-765-2269
Practice Address - Fax:845-765-2268
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03781811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP803653OtherOXFORD
NY01961724Medicaid
CT251339219OtherCIGNA
NY100367HOtherINDEPENDENT HEALTH
MO121447OtherMBH
AL1433866737OtherCARE PLUS HEALTH PLAN
KY340435OtherMHN
MON27361OtherMBCC PRUDENTIAL
MO095408000OtherMBH IBR
MO7483043OtherMBH
NY996118OtherMVP
NYN7B32OtherEBCBS
NYN458A1OtherEBCBS
NYP11101072OtherMULTIPLAN
CTP2105998OtherOXFORD
TX0005397562OtherAETNA US HEALTHCARE
MA1031400OtherBEACON HEALTH STRATEGIES
NY135395OtherAFFINITY HEALTH PLAN
MO274646000OtherMBH
MON27361OtherMBCC PRUDENTIAL