Provider Demographics
NPI:1396069704
Name:SKINNER, ALYSON H (PHD)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:H
Last Name:SKINNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:H
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:410 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1541
Mailing Address - Country:US
Mailing Address - Phone:631-606-0430
Mailing Address - Fax:
Practice Address - Street 1:410 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1541
Practice Address - Country:US
Practice Address - Phone:631-606-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020674103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling