Healthcare Provider Details

I. General information

NPI: 1346908654
Provider Name (Legal Business Name): ALISSA MARIE PRINCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 CARLETON AVE FL 8
CENTRAL ISLIP NY
11722-4506
US

IV. Provider business mailing address

320 CARLETON AVE
CENTRAL ISLIP NY
11722-4506
US

V. Phone/Fax

Practice location:
  • Phone: 631-663-4304
  • Fax: 631-944-8397
Mailing address:
  • Phone: 631-663-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103356-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: