Provider Demographics
NPI:1669466017
Name:ALESSI, SUSAN I (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:I
Last Name:ALESSI
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 1:703 W FERRY ST APT A15
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1635
Mailing Address - Country:US
Mailing Address - Phone:716-881-2472
Mailing Address - Fax:716-881-2472
Practice Address - Street 1:703 WEST FERRY ST APT A15
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1635
Practice Address - Country:US
Practice Address - Phone:716-881-2472
Practice Address - Fax:716-881-2472
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006249103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6884608OtherVO/GHI
NY00020349601OtherUNIVERA
NY6100977OtherINDEPENDENT HEALTH
NY000507945001OtherBCBS OF WNY
NYIA1117Medicare PIN