Provider Demographics
NPI:1194031963
Name:SEIDMAN, ALYSON KARA (LCSW)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:KARA
Last Name:SEIDMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 JEROME AVE.
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804
Mailing Address - Country:US
Mailing Address - Phone:617-797-0856
Mailing Address - Fax:
Practice Address - Street 1:12 JEROME AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-3804
Practice Address - Country:US
Practice Address - Phone:617-797-0856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080610104100000X
NY0850511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY085051OtherLICENSE NUMBER