Provider Demographics
NPI:1184355547
Name:ALAM, SUMERA
Entity type:Individual
Prefix:
First Name:SUMERA
Middle Name:
Last Name:ALAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ASTORIA BLVD APT 2H
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-5208
Mailing Address - Country:US
Mailing Address - Phone:917-854-8258
Mailing Address - Fax:
Practice Address - Street 1:110 ASTORIA BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-5214
Practice Address - Country:US
Practice Address - Phone:917-854-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116026-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty