Provider Demographics
NPI:1841955028
Name:ALIA-KLEIN, NELLY
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:ALIA-KLEIN
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 1:147 LANG RD
Mailing Address - Street 2:
Mailing Address - City:ACCORD
Mailing Address - State:NY
Mailing Address - Zip Code:12404-5943
Mailing Address - Country:US
Mailing Address - Phone:917-574-4419
Mailing Address - Fax:
Practice Address - Street 1:147 LANG RD
Practice Address - Street 2:
Practice Address - City:ACCORD
Practice Address - State:NY
Practice Address - Zip Code:12404-5943
Practice Address - Country:US
Practice Address - Phone:917-574-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015765-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical