Provider Demographics
NPI:1073186755
Name:SOEP, ALISON ROSE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:ROSE
Last Name:SOEP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:AVITAL
Other - Middle Name:
Other - Last Name:SOEP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1067 MORA PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1113
Mailing Address - Country:US
Mailing Address - Phone:516-776-5898
Mailing Address - Fax:
Practice Address - Street 1:1067 MORA PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1113
Practice Address - Country:US
Practice Address - Phone:516-776-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2022-03-22
Deactivation Date:2021-07-21
Deactivation Code:
Reactivation Date:2021-09-09
Provider Licenses
StateLicense IDTaxonomies
NY024797103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical