Healthcare Provider Details

I. General information

NPI: 1811447469
Provider Name (Legal Business Name): ALESSANDRA ELISA HADDAD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALESSANDRA WAYLON LCSW

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 OLD MAIN ST STE 105C
FISHKILL NY
12524-1848
US

IV. Provider business mailing address

400 RELLA BLVD STE 207-606
MONTEBELLO NY
10901-4241
US

V. Phone/Fax

Practice location:
  • Phone: 914-338-8063
  • Fax:
Mailing address:
  • Phone: 914-338-8063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: