Provider Demographics
NPI:1740087089
Name:FEA, ALISA (LMSW)
Entity type:Individual
Prefix:MISS
First Name:ALISA
Middle Name:
Last Name:FEA
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 EAGLE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1025
Mailing Address - Country:US
Mailing Address - Phone:845-826-5449
Mailing Address - Fax:
Practice Address - Street 1:45 S ROUTE 9W STE 209
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1053
Practice Address - Country:US
Practice Address - Phone:845-941-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126369-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker