Healthcare Provider Details

I. General information

NPI: 1700319571
Provider Name (Legal Business Name): ALINA KHEYSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BAY 38TH ST APT 1A
BROOKLYN NY
11214-4417
US

IV. Provider business mailing address

64 BAY 38TH ST APT 1A
BROOKLYN NY
11214-4417
US

V. Phone/Fax

Practice location:
  • Phone: 718-915-3851
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number100147
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number100147
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: