Healthcare Provider Details

I. General information

NPI: 1528502705
Provider Name (Legal Business Name): ALISSA CALA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 EASTCHESTER RD
BRONX NY
10461-2604
US

IV. Provider business mailing address

333 E 56TH ST APT 6L
NEW YORK NY
10022-3758
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-8040
  • Fax: 718-405-8047
Mailing address:
  • Phone: 718-405-8040
  • Fax: 718-405-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number084472-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: