Provider Demographics
NPI:1922250281
Name:MOADEL, ALYSON (PHD)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:MOADEL
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 1:1300 MORRIS PARK AVE
Mailing Address - Street 2:ALBERT EINSTEIN COLLEGE, BELFER BUILDING, 13TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1900
Mailing Address - Country:US
Mailing Address - Phone:718-430-2696
Mailing Address - Fax:
Practice Address - Street 1:1300 MORRIS PARK AVE
Practice Address - Street 2:ALBERT EINSTEIN COLLEGE, BELFER BUILDING, 13TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1900
Practice Address - Country:US
Practice Address - Phone:718-430-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013664103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth