Provider Demographics
NPI:1932759958
Name:BENI-SHORE, ALYSSA (LCSW LLC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BENI-SHORE
Suffix:
Gender:F
Credentials:LCSW LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 PHELPS AVE
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2423
Mailing Address - Country:US
Mailing Address - Phone:646-300-2851
Mailing Address - Fax:
Practice Address - Street 1:300 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-1350
Practice Address - Country:US
Practice Address - Phone:646-300-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0839741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical