Provider Demographics
NPI:1801122783
Name:BARENBAUM, ALYSSA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:BARENBAUM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 E 17TH ST
Mailing Address - Street 2:APT 516
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3750
Mailing Address - Country:US
Mailing Address - Phone:347-275-7324
Mailing Address - Fax:347-275-7324
Practice Address - Street 1:915 E 17TH ST
Practice Address - Street 2:APT 516
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3750
Practice Address - Country:US
Practice Address - Phone:347-275-7324
Practice Address - Fax:347-275-7324
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075119-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker