Provider Demographics
NPI:1841060282
Name:ADOM, ALICE N
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:N
Last Name:ADOM
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 1:630 GRAMATAN AVE APT 4W
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1836
Mailing Address - Country:US
Mailing Address - Phone:914-263-9527
Mailing Address - Fax:
Practice Address - Street 1:630 GRAMATAN AVE APT 4W
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-1836
Practice Address - Country:US
Practice Address - Phone:914-263-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0863321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty