Provider Demographics
NPI:1942858113
Name:SCHNEIDER BERG, ALISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:SCHNEIDER BERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-124 ANANIA DR APT 201
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2015
Mailing Address - Country:US
Mailing Address - Phone:808-728-0514
Mailing Address - Fax:
Practice Address - Street 1:94-124 ANANIA DR APT 201
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2015
Practice Address - Country:US
Practice Address - Phone:808-728-0514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW44541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical