Provider Demographics
NPI:1356586291
Name:HERCHENRODER, ALISON (PSYD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:HERCHENRODER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:KLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:11 SHELBY RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4819
Mailing Address - Country:US
Mailing Address - Phone:631-379-1049
Mailing Address - Fax:
Practice Address - Street 1:460 W 34TH ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2320
Practice Address - Country:US
Practice Address - Phone:212-273-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017875-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical