Healthcare Provider Details

I. General information

NPI: 1164991451
Provider Name (Legal Business Name): ALYSSA ASHLY KONDOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA ASHLY PALMER LCSW

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 S MAIN ST
NEWTOWN CT
06470-2791
US

IV. Provider business mailing address

22 YALE AVE
MIDDLEBURY CT
06762-2712
US

V. Phone/Fax

Practice location:
  • Phone: 203-456-4617
  • Fax:
Mailing address:
  • Phone: 203-556-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11559
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: