Healthcare Provider Details

I. General information

NPI: 1184164881
Provider Name (Legal Business Name): ALIZA SHYNELLE THOMAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 FRANKLIN AVE FL 2
GARDEN CITY NY
11530-7400
US

IV. Provider business mailing address

667 STONELEIGH AVE STE 202
CARMEL NY
10512-2455
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-5908
  • Fax: 845-622-3636
Mailing address:
  • Phone: 845-279-5908
  • Fax: 845-622-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085280
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: