Provider Demographics
NPI:1427048669
Name:RIVERA ORSINI, ALLYAN WATSON (LCSW RBCD)
Entity type:Individual
Prefix:MS
First Name:ALLYAN
Middle Name:WATSON
Last Name:RIVERA ORSINI
Suffix:
Gender:F
Credentials:LCSW RBCD
Other - Prefix:MS
Other - First Name:ALLYAN
Other - Middle Name:WATSON
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW RBCP
Mailing Address - Street 1:45 INLET DR
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6804
Mailing Address - Country:US
Mailing Address - Phone:631-957-0788
Mailing Address - Fax:631-957-0788
Practice Address - Street 1:17 FORDHAM RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-5803
Practice Address - Country:US
Practice Address - Phone:631-321-7011
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0414081103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR041408OtherVYTRA
NY537688OtherVALUE OPTIONS
NY537688OtherVALUE OPTIONS